Background: Among all causes of maternal mortality from non-obstetric disorders, heart defects of different etiology are 15-20%, and the specific gravity of this pathology in the structure of maternal mortality and morbidity remains high due to the fact that these patients traditionally constitute a high-risk group for the development of thromboembolic disorders and death.

Aims: The management of pregnancy with a high risk of cardiovascular complications.

Methods: We report the case of 32-year-old woman with Bland-White-Garland (BWG) syndrome (the anomalous origin of the left coronary artery from the pulmonary artery, ALCAPA). In 2011 she had a reimplantation of the left coronary artery in the ascending aorta with the plastic of the pulmonary artery and mitral valves repair. She suffered from cardiac dysrhythmia by the ventricular extra systole, paroxysmal form of supraventricular tachycardia, heart failure (HF) II functional class (FC) NYHA. She was on warfarin therapy. This is her 2^nd pregnancy. She refused to switch on LMWH/UH because in the previous pregnancy there was constant bleeding that ended in a miscarriage.

Results: The entire pregnancy she was given warfarin under the control of INR. There were repeated hospitalizations due to complaints of paroxysmal atrial flutter. At 38 weeks the patient had given birth to a healthy full-term baby girl without malformations, 2750 g, 47 cm and an Apgar score of 8/9 by cesarean section as planned.

Conclusions: Experience of pregnancy management in women with arterial conduits with ALCAPA is small. It should be kept in mind that outside of pregnancy, artificial valves are a direct indication to for a lifelong anticoagulant therapy. However, if out-of-pregnancy anticoagulation is provided by oral anticoagulants (mainly warfarin in most of the countries), then during the pregnancy there are different schemes of anticoagulant therapy. In this case warfarin was the method of choice.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/antithrombotic-therapy-for-pregnant-woman-with-bland-white-garland-syndrome-and-prosthetic-mitral-valves/