Clinical Success of Re-Redo Pulmonary Valve and Pulmonary Trunk Homograft Replacement During the Second Trimester of Pregnancy

This manuscript reports a pregnant patient who developed thrombosis of her mechanical pulmonary valve, necessitating re-replacement of the valve and the trunk.  A 30-year-old woman at 18 weeks of gestation presented with severe fatigue. Her medical history was significant for congenital pulmonary atresia with a ventricular septal defect, prior placement of a Blalock-Taussig shunt, multiple graft replacements, and a mechanical pulmonary valve replacement. The authors were concerned about prosthetic valve thrombosis after echocardiography, which was subsequently confirmed by cardiac MRI.  Given her pregnancy, conventional medical therapy was attempted first but proved unsuccessful; therefore, surgical intervention was deemed necessary.  The patient underwent re-replacement of the pulmonary valve and trunk using a pulmonary homograft. The procedure was performed on a beating heart, with cardiopulmonary bypass (CPB) initiated via a pulsatile roller pump. Her postoperative course was favorable, and she subsequently delivered a healthy infant at 38 weeks of gestation.  This case highlights that pulmonary valve re-replacement can be performed safely during pregnancy in the setting of mechanical valve thrombosis. The authors attribute the favorable outcome in part to the use of a beating-heart technique and optimized CPB parameters.