田端 強志¹, 杉山 恵¹, 丹治 直映¹, 藺藤 佑哉², 斎藤 綾², 本村 昇², 清水 一寛³, 高田 伸夫¹

Tsuyoshi TABATA¹, Megumi SUGIYAMA¹, Naoaki TANJI¹, Yuya ITOU², Aya SAITOU², Noboru MOTOMURA², Kazuhiro SHIMIZU³, Nobuo TAKADA¹

¹東邦大学医療センター佐倉病院生理機能検査部, ²東邦大学医療センター佐倉病院心臓血管外科, ³東邦大学医療センター佐倉病院循環器センター

¹Department of Clinical Physiology, Toho University Medical Center Sakura Hospital, ²Department of Cardiovascular Surgery, Toho University Medical Center Sakura Hospital, ³Department of Cardiovascular Center, Toho University Medical Center Sakura Hospital

キーワード : prosthetic valve, pregnancy, stuck valve, anticoagulation, heparin

機械弁置換後の妊娠管理は容易ではなく，様々な血栓塞栓症の危険性が増すといわれており，より厳格な抗凝固療法が必要となる．機械弁置換後の血栓塞栓症予防には通常，ワルファリンが用いられるが，妊娠初期に使用すると催奇形性がある．一方，ヘパリンはワルファリンと比較して催奇形性は少ないが，血栓塞栓症の割合は増加するといわれている.今回我々は，僧帽弁位機械弁置換術後の女性に対して妊娠前に抗凝固療法をワルファリンからヘパリン在宅自己注射へ変更後，5ヵ月後にstuck valveをきたした1例を経験したので報告する．

It is said that pregnancy in a woman with a mechanical prosthetic heart valve increases the risk of thromboembolic complications. Therefore, more thorough anticoagulation therapies are needed. Usually, warfarin is used to prevent the development of thromboembolism after mechanical prosthetic heart replacement, but it also causes fetal abnormalities if taken in early pregnancy. On the other hand, heparin therapy has less risk of teratogenicity than warfarin, but increases the risk of thromboembolic complications in pregnancy. We herein present a case of a pregnant woman with a stuck mechanical mitral valve. Before she was pregnant, her anticoagulation therapy was switched from warfarin to heparin calcium self-injection at home. Her mechanical heart valve, however, was found to be stuck 5 months after the change in therapies.