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Mitral valve-in-valve implantation during pregnancy
  1. Mark Zachary Johnson1,2,
  2. Nicholas James Damianopoulos2,
  3. Felicity Lee3 and
  4. Gerald Yong3
  1. 1Anaesthetics, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  2. 2Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
  3. 3Cardiology Dapartment, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  1. Correspondence to Nicholas James Damianopoulos; NicholasJDamianopoulos{at}


A 32-year-old, 11-week pregnant African woman with known rheumatic heart disease presented to the emergency department with worsening shortness of breath on exertion. She had undergone a double bioprosthetic valve replacement and left atrial appendage resection 8 years prior for severe mitral stenosis, moderate mitral regurgitation and moderate aortic regurgitation. A transo-oesophageal echocardiography at this presentation confirmed a morphologically calcified and stenosed mitral bioprosthesis, with moderate stenosis of her aortic bioprosthesis. Her multidisciplinary team, including cardiologists, cardiothoracic surgeons and obstetricians, came to a consensus decision to proceed with a transseptal transcatheter valve implantation within the mitral valve prosthesis (valve-in-valve implantation). Transthoracic echocardiography performed 2 months post procedure showed satisfactory mitral valve gradients and at 30 weeks’ gestation, she successfully delivered her fifth child. 2 years later, the valve in valve complex is still functioning well.

  • interventional cardiology
  • valvar diseases
  • pregnancy

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  • FL and GY are joint senior authors.

  • MZJ and NJD are joint first authors.

  • Contributors Supervised by GY. The patient was under the care of MJD, FL and GY. Report written by NJD, MZJ and FL. Final review and editing completed by GY, MZJ, NJD, FL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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