Fourth mitral valve replacement in a 15-year span in a woman of childbearing age.

There is no report of four valve replacement surgeries in a woman during 15-year follow-up. A 23-year-old female was diagnosed at 7 years with rheumatic fever. She developed severe mitral regurgitation and at the same age a prosthetic valve was placed. In the next 15 years her mitral valve was changed 3 times because of clinical, echocardiographic, and histopathologic evidence of thrombosis. Her coagulation tests all showed infratherapeutic international normalized ratio and by the age of 15 years she had had an ischemic stroke with total recovery. She developed a normal pregnancy by the age of 19 years with no complications. This case exposes the complexity of the decision making that cardiologists face in terms of choosing the type of prosthetic valve that should be indicated in a woman of childbearing age. With each surgical valve replacement prognosis is less favorable and choosing the best therapy remains a challenge for the heart team. < Learning objective: Valvular heart disease remains a challenging problem due to anticoagulation issues. Prosthetic valvular replacements need a thorough follow-up for anticoagulation goals. Women of childbearing age can both have mechanic and biologic prosthesis.>.