Perioperative management of a pregnant patient with a mechanical heart valve undergoing appendectomy: a case report.

INTRODUCTION AND

IMPORTANCE

Managing pregnant patients with mechanical heart valves who require non-cardiac surgery presents unique challenges, particularly in balancing anticoagulation to prevent thromboembolic complications while minimizing bleeding risks. This case report discusses the perioperative management of a pregnant patient with a mechanical mitral valve undergoing emergency appendectomy.

CASE PRESENTATION: A 28-year-old pregnant woman at 22 weeks gestation with a history of rheumatic heart disease and a mechanical mitral valve presented with acute appendicitis. Anticoagulation therapy was shifted from warfarin to low-molecular-weight heparin (LMWH) to mitigate the risks of bleeding and teratogenicity. Intravenous unfractionated heparin (UFH) was used perioperatively to maintain adequate anticoagulation. A multidisciplinary team guided the patient's care, and she underwent a successful laparoscopic appendectomy with stable maternal and fetal outcomes.

CLINICAL DISCUSSION: Perioperative anticoagulation in pregnant women with mechanical heart valves is critical to avoiding valve thrombosis while minimizing the risk of bleeding. In this case, using LMWH as a bridging therapy and UFH during surgery proved effective in balancing these risks. The case underscores the importance of a coordinated multidisciplinary approach to optimize maternal and fetal outcomes during emergency surgery.

CONCLUSION

This case highlights the complexities of managing anticoagulation in pregnant patients with mechanical valves requiring non-cardiac surgery. With appropriate anticoagulation adjustment, multidisciplinary planning, and vigilant perioperative monitoring, both maternal and fetal outcomes can be favorable in such high-risk situations.