Redo aortic valve replacement in twin pregnancy: navigating high-risk cardiac surgery with maternal and fetal success - A case report.

Introduction and importance: Redo aortic valve replacement (AVR) in pregnancy presents significant challenges due to maternal hemodynamics, fetal well-being, and anticoagulation management. Prosthetic valve stenosis is a life-threatening condition and can significantly alter the maternal and fetal outcome without treatment. We report a case of a pregnant woman with twin gestation who developed prosthetic valve stenosis due to pannus formation and requiring redo AVR. Case presentation: A 31-year-old woman, pregnant with dichorionic diamniotic twins at 14 weeks, presented with worsening dyspnea. She had undergone mechanical AVR at 11 years of age and was on warfarin; however, she stopped taking warfarin since 2014. Echocardiography revealed prosthetic aortic valve stenosis, with severely elevated transvalvular gradients. She underwent redo AVR with a 21 mm On-X mechanical valve following aortic root enlargement. Postoperatively, she developed complete atrioventricular dissociation, requiring a permanent pacemaker. Multidisciplinary care ensured fetal viability, and she was discharged in stable condition with appropriate anticoagulation management. Discussion: Redo AVR during pregnancy requires meticulous planning, balancing maternal and fetal risks. This case highlights the complexities of anticoagulation strategies, surgical execution, and maternal-fetal monitoring. Conclusion: A multidisciplinary approach is essential to optimize outcomes in pregnant patients undergoing redo AVR. Long-term follow-up is crucial for continued surveillance of prosthetic valve function and maternal health.