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European Journal of Echocardiography Advance Access published online on November 20, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep180
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

An ethical dilemma: severe ischaemic mitral regurgitation and acute coronary syndrome in a 49-year-old pregnant woman

Anna S. Herrey1,*, Sarah J. Germain2, Catherine Nelson-Piercy2, Raffi R. Kaprielian1, Phillip Bennett3, Prakash P. Punjabi4 and Petros Nihoyannopoulos1

1 Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
2 Department of Obstetric Medicine, Queen Charlotte's Hospital, Imperial College London, UK
3 Department of Obstetric, Queen Charlotte's Hospital, Imperial College London, UK
4 Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK

Received 23 April 2009; accepted after revision 21 October 2009.

* Corresponding author. Tel: +44 20 8383 3948, Fax: +44 20 8383 4392, Email: anna.john{at}doctors.org.uk


  Abstract

We report the case of a 49-year-old woman who presented with symptomatic severe mitral regurgitation secondary to previous myocardial infarction. During the work-up for surgery, she was found to be pregnant. This report explores the difficulties and ethical dilemmas encountered dealing with the need for urgent valve surgery and coronary revascularization in association with an unplanned, but wanted pregnancy in an older woman.

Keywords: Ischaemic heart disease; Mitral regurgitation; Pregnancy


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