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Emergency Surgery with Mechanical Valve — EECC MCQ

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HardValvular Heart DiseaseEmergency Surgery with Mechanical ValveEECC

A 30-year-old with a mechanical mitral valve taking 7.5 mg warfarin daily wishes to conceive. Which pre-pregnancy plan best minimises maternal valve-thrombosis and fetal risks?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Agree an individual Pregnancy Heart Team anticoagulation plan before conception

No single regimen removes both maternal and fetal risk, particularly with a high warfarin dose and a mechanical mitral valve. A Pregnancy Heart Team must agree monitoring and trimester-specific VKA or dose-adjusted heparin strategy before conception. DOACs, unplanned continuous warfarin, interruption and aspirin monotherapy expose the mother to unacceptable valve-thrombosis risk.

Reference: 2025 ESC Guidelines for cardiovascular disease and pregnancy. https://academic.oup.com/eurheartj/article/46/43/4462/8234487