{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T21:05:54Z","timestamp":1773176754647,"version":"3.50.1"},"reference-count":18,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,10,19]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>A 32-year-old, 11-week pregnant African woman with known rheumatic heart disease presented to the emergency department with worsening shortness of breath on exertion. She had undergone a double bioprosthetic valve replacement and left atrial appendage resection 8 years prior for severe mitral stenosis, moderate mitral regurgitation and moderate aortic regurgitation. A transo-oesophageal echocardiography at this presentation confirmed a morphologically calcified and stenosed mitral bioprosthesis, with moderate stenosis of her aortic bioprosthesis. Her multidisciplinary team, including cardiologists, cardiothoracic surgeons and obstetricians, came to a consensus decision to proceed with a transseptal transcatheter valve implantation within the mitral valve prosthesis (valve-in-valve implantation). Transthoracic echocardiography performed 2\u2009months post procedure showed satisfactory mitral valve gradients and at 30 weeks\u2019 gestation, she successfully delivered her fifth child. 2 years later, the valve in valve complex is still functioning well.<\/jats:p>","DOI":"10.1136\/bcr-2021-244270","type":"journal-article","created":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T12:20:39Z","timestamp":1637670039000},"page":"e244270","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Mitral valve-in-valve implantation during pregnancy"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1503-8955","authenticated-orcid":false,"given":"Mark Zachary","family":"Johnson","sequence":"first","affiliation":[{"name":"Anaesthetics, Fiona Stanley Hospital, Murdoch, Western Australia, Australia"},{"name":"Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3513-1364","authenticated-orcid":false,"given":"Nicholas James","family":"Damianopoulos","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3840-2385","authenticated-orcid":false,"given":"Felicity","family":"Lee","sequence":"additional","affiliation":[{"name":"Cardiology Dapartment, Fiona Stanley Hospital, Murdoch, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald","family":"Yong","sequence":"additional","affiliation":[{"name":"Cardiology Dapartment, Fiona Stanley Hospital, Murdoch, Western Australia, 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