An effective anticoagulation is critical in pregnant patients with prosthetic heart valves. Inherited disorders may interfere with the coagulation cascade and may be associated with obstetrical complications as well as with prosthetic valve-derived complications. The patient in the present case had a history of recurrent prosthetic heart valve thrombosis (PHVT) despite an effective anticoagulation. She underwent a thrombolysis with low-dose prolonged infusion of tissue-type plasminogen activator for the management of her recurrrent prosthetic valve thrombosis. The genetic testing showed homozygous mutations of methylenetetrahydrofolate reductase (MTHFR) A 1298 C and heterozygous mutations of beta-fibrinogen 455 G-A. Inherited disorders such as MTHFR A 1298 C and fibrinogen 455G/A polymorphisms may be involved in the pathogenesis of recurrent PHVT and/or pregnancy loss.
Abortion, Habitual* ; Abortion, Spontaneous ; Female ; Fibrinogen ; Genetic Testing ; Heart Valves ; Humans ; Methylenetetrahydrofolate Reductase (NADPH2) ; Mitral Valve* ; Pregnancy ; Thrombophilia ; Thrombosis* ; Tissue Plasminogen Activator

BACKGROUND: Vitamin D deficiency and a high mean platelet volume (MPV) are related to cardiovascular disease. We investigated whether vitamin D deficiency is associated with high MPV. METHODS: This study included 434 patients without chronic disease who were not taking vitamin D or calcium supplements. Vitamin D was measured by chemiluminescent microparticle immunoassay on the Architect-I2000 system (Abbott Diagnostics, USA), and MPV was measured on the Cell-Dyn Ruby analyzer (Abbott Diagnostics). Patients were divided into Groups 1 (138 [men/women, 46/92]), 2 (148 [men/women, 54/94]), and 3 (148 [men/women, 50/98]) according to vitamin D levels of <10 ng/mL, 10-20 ng/mL, and >20 ng/mL, respectively. RESULTS: The vitamin D level in Group 1 (7.7+/-1.9 ng/mL) was lower than that in Group 2 (15.1+/-1.6 ng/mL, P<0.001) and Group 3 (25.6+/-6.3 ng/mL, P<0.001). The MPV in Group 3 (7.5+/-1.0 fL) was lower than that in Group 1 (8.1+/-1.1 fL, P<0.001) and Group 2 (7.9+/-1.0 fL, P=0.009). Linear regression analysis showed that low levels of vitamin D (beta=-0.109, P=0.019) was independently associated with increased MPV. CONCLUSIONS: There was a strong association between a low vitamin D level and a high MPV; therefore, vitamin D deficiency may be associated with increased MPV.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Blood Glucose/analysis ; Blood Platelets/*cytology ; Cell Size ; Female ; Humans ; Immunoassay ; Luminescent Measurements ; Male ; Middle Aged ; Vitamin D/*analysis ; Vitamin D Deficiency/metabolism/pathology ; Young Adult