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JAMA Cardiology Clinical Challenge
November 11, 2020

A Pregnant Woman With Shortness of Breath

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 3Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Cardiol. 2021;6(1):113-114. doi:10.1001/jamacardio.2020.5587

A 40-year-old woman presented with a history of mitral valve (MV) endocarditis leading to MV repair (without annuloplasty) 15 years ago. Four years ago while pregnant, she had recurrent endocarditis complicated by severe symptomatic mitral regurgitation, but she was successfully brought to term and had a cesarean delivery. Post partum, her symptoms resolved, but she had persistent marked mitral regurgitation related to a severely deformed posterior leaflet. She wished to have another child, and after extensive counseling she elected to undergo a complex redo MV repair (annuloplasty) 2 years ago. She developed perioperative atrial fibrillation but declined anticoagulation and has not had further arrhythmias. Serial transthoracic echocardiograms have demonstrated normal biventricular function and pulmonary pressures. Her postoperative MV gradient was 10 mm Hg (heart rate, 90 beats per minute [bpm]) and has been stably elevated since surgery.

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