Figure 5.

Mechanical aortic valve thrombosis in a pregnant woman. A 38‐year‐old woman gravida 1 para 0, presents with new onset shortness of breath at 12 weeks of pregnancy. She has a history of a bileaflet mechanical aortic valve placed 15 years prior, secondary to endocarditis and a bicuspid aortic valve. Transthoracic echocardiogram prior to pregnancy revealed a normally functioning aortic valve mechanical prosthesis. She was counseled prior to pregnancy and opted to use subcutaneous heparin during weeks 6 to 12, and then use warfarin until week 36. Physical examination at the time of symptoms revealed muffled mechanical closing clicks, and a new grade III/VI systolic murmur in the aortic position. Transthoracic echocardiogram reveals a newly elevated forward flow mean gradient of 52 mm Hg (A). Subsequently, a transesophageal echocardiogram revealed thrombus (B, arrows) attached to the valve leaflets and the annulus (midesophageal view, 120°). Spontaneous abortion occurred (prior to transesophageal echocardiogram was performed), diagnosed at week 12. CW indicates continuous wave Doppler.