Advanced Rheumatic Heart Disease Complicated by Pregnancy, Mitral Valve Disease, Pulmonary Hypertension, and Left Atrial Thrombus: A Multidisciplinary Case Report from Resource-Limited Settings.
Nouh Ismail Botan, Sadam Ismail Ahmed, Fatima Hachi Imaan et al.
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Case in brief
A 27-year-old woman in late pregnancy presented with progressive dyspnea, palpitations, leg swelling, cough, and fatigue. Echocardiography showed an enlarged left atrium, moderate mitral stenosis with mild regurgitation and fixed leaflets, pulmonary hypertension, poor right ventricular function, and a large left atrial thrombus; left ventricular ejection fraction was preserved at 58%. She received multidisciplinary care, including furosemide, metoprolol, and enoxaparin. Labor began spontaneously while she was receiving low-molecular-weight heparin, and she delivered a 2.1 kg neonate with good Apgar scores.
What made this case unusual
The combination of advanced rheumatic mitral valve disease, pulmonary hypertension, poor right ventricular function, and a large left atrial thrombus was identified in a woman presenting near term.
Diagnostic / clinical pearl
In a pregnant patient with suspected decompensated valvular disease, echocardiography can reveal clinically important complications beyond valve severity, including pulmonary hypertension, right ventricular dysfunction, and left atrial thrombus.
Why it matters
The report underscores the role of coordinated multidisciplinary care in managing high-risk cardiac disease during pregnancy, including in a resource-limited setting.