Search Results for: Associazione FANS e Warfarin

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This study assessed whether electric fans limit core temperature increases in adults aged 65 to 85 years exposed to conditions similar to those experienced in homes during heat waves in North America.

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Circulation, Volume 150, Issue Suppl_1, Page A4145883-A4145883, November 12, 2024. Introduction/Background:While the international normalized ratio (INR), a marker of functioning of the extrinsic and final common pathways of the coagulation cascade is associated with increased intracerebral hemorrhage (ICH) mortality for patients taking warfarin, it is not understood how it might be associated with outcomes in patients taking direct oral anticoagulants (DOACs), given the inconsistent and variable effect of DOACs on INR.Research Questions/Hypothesis:To determine whether INR is associated with increased ICH severity in patients with recent exposure to a DOAC.Methods/Approach:We included patients taking Apixaban or Rivaroxaban prior to acute presentation with ICH to hospitals participating in the Get With the Guidelines – Stroke registry, a nationwide quality improvement registry. The primary exposure was INR, which we modeled as a continuous variable with restricted cubic splines. The primary endpoint was stroke severity on presentation, measured by the National Institutes of Health Stroke Scale (NIHSS). Secondary endpoints included Glasgow Coma Scale (GCS) =21 (aOR 1.02 [95% CI 1.00-1.04, p=0.03] per 0.1 above 1.1) and in-hospital mortality (aOR 1.11 [95% CI 1.05-1.16, p

Circulation, Volume 150, Issue Suppl_1, Page A4139226-A4139226, November 12, 2024. Background:Anticoagulation is the standard treatment for the majority of patients with atrial fibrillation (AF) to reduce the risk of stroke. Anticoagulation is also utilized in patients with end-stage renal disease (ESRD) on hemodialysis (HD) who have AF. Such patients are at high risk for bleeding and stroke. However, limited data is available regarding utility of anticoagulation in such patients. The goal of this project was to assess the efficacy of anticoagulation to reduce the risk of stroke for patients with ESRD on HD who developed new onset AF.Methods:The national Veterans Affairs (VA) electronic health records were utilized to identify patients with ESRD on HD from 01/01/2000 to 01/01/2018. Those with AF prior to HD were excluded. In addition, those with stroke, mitral or aortic valve surgery prior to AF were excluded. Anticoagulants included warfarin, or apixaban, rivaroxaban, edoxaban and dabigatran, collectively termed DOACs. Patients were considered to be on an anticoagulation if they received anticoagulation for >1 month. All diagnoses were based on International Classification of Disease (ICD) 9thand 10thversions, and Current Procedural Terminology codes. Follow up period extended from the onset of AF to 01/01/2020 or death.Results:Over the study period 12,559,292 patients visited any of the VAs nationally. Of these, 89,081 were on HD without prior AF. Of those, 17,192 (19.3%) developed new AF. Of these 13,649 had no stroke, mitral or aortic surgery prior to the AF diagnosis. Of the 9,227 patients in the no anticoagulation cohort, 476 patient subsequently had stroke (5.16%). Of the 3,708 warfarin treated patients, 533 had subsequent stroke (14.37). Of the 358 DOAC patients, 34 (9.95%) had subsequent stroke. The difference in the stroke rates between those anticoagulated and those not anticoagulated was significant (P

Circulation, Volume 150, Issue Suppl_1, Page A4141690-A4141690, November 12, 2024. Background:Arterial calcification often occurs with bone mineral loss in osteoporosis, for which bisphosphonates are a standard therapy. Mice lacking the matrix GLA protein (Mgp) exhibit lethal arterial calcification and cranial bone formation deficits causing dental malocclusion. Mgp not only binds to hydroxyapatite but also inhibits the bone morphogenic protein activation of Runx2 transcription factor, which drives the osteogenic conversion of arterial smooth muscle cells (SMCs). Prior studies showed bisphosphate therapy ameliorates warfarin-induced arterial calcification in rats. This study investigated whether bisphosphonate (Alendronate,ALN) treatment could address bone deficits and arterial calcification in Mgp-null mice.Methods:Mgp-null mice were subjected to various doses of Alendronate therapy starting at weaning or postnatal day 3. Dental malocclusion severity was assessed by incisor trimming frequency. Arterial calcification was quantified by Alizarin red staining and µ-CT.Results:In Mgp-null mice, susceptibility to aortic artery calcification was not uniform but varied by location, with calcification highest at the proximal aorta. Of note, recurring nodes of calcification were found to correspond to branch points of vertebral arteries, with internodal regions showing less calcification. Alendronate therapy started at 3 weeks of age ameliorated dental malocclusion in Mgp-null mice of both sexes and improved but did not normalize body weight gain in males and females. However, no improvement in arterial calcification was observed at 7 weeks. Similarly, Alendronate therapy at lower doses from postnatal day 3 for 5 weeks ameliorated dental malocclusion and improved but did not normalize body weight gain in both sexes, while at higher doses, Alendronate prevented incisor development and caused growth retardation in both wild type and Mgp-null mice. However, Alendronate accelerated the appearance of Runx2 in SMCs of the aorta and worsened internodal arterial calcification in Mgp-null mice in a dose-dependent fashion, but not in Mgp-hemizygous or wild type mice.Conclusion:Our study reveals an important dichotomy in Mgp’s function in bone and arteries. The bone deficits in Mgp-null mice, highlighted by incisor malocclusion, could be rescued by bisphosphonate treatment, whereas the arterial calcification could not. Thus, Mgp performs an essential function to prevent arterial calcification that cannot be restored by bisphosphonate therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4147071-A4147071, November 12, 2024. Introduction/Background:Marantic endocarditis and valvulitis are cardiovascular manifestations of autoimmune disease that can be challenging to diagnose.Case Presentation:A 23-year-old female with SLE presented with brief episodes of intermittent left eye vision loss and left sided weakness. She also reported fevers, a malar rash, and new onset dyspnea on exertion.Serologic work-up was consistent with an SLE flair. MRI of the brain/orbits demonstrated two acute infarcts in the frontal and parieto-occipital lobes. CTA head and neck did not show any large vessel vasculitis. Transthoracic echocardiography showed thickening of the mitral valve (MV) leaflets, with moderate MR and an elevated MV gradient of 11 mm Hg. The posterior leaflet was not visualized, concerning for absent or hypoplastic posterior leaflet. A transesophageal echocardiogram was performed and showed severe thickening of posterior mitral leaflet with restricted motion and shortening secondary to extensive thrombus burden. In addition, there was evidence of thrombus at the tip of the anterior MV leaflet. The patient was managed with high dose steroids and warfarin for SLE flair and marantic endocarditis, respectively.Two months later, she presented with amaurosis fugax. Cardiac MRI showed thickened MV leaflets with delayed enhancement along the posterior leaflet and MV annulus consistent with an organized thrombus. After multidisciplinary discussion, the patient underwent surgical MV replacement with a bioprosthetic valve. Intraoperative evaluation revealed severely thickened MV leaflets with fused commissures. In addition, there was fusion of the posterior leaflet and lateral side of the anterior leaflet to the papillary muscles as a result of thickened and shortened chordae. These findings were believed to be due to inflammatory changes involving the MV apparatus. Surgical pathology confirmed the diagnosis of valvulitis. The patient has done well post operatively.Conclusion:Valvulitis and marantic endocarditis can have devastating consequences if not treated promptly. Use of multimodality imaging can aid in the diagnosis. Multidisciplinary discussion is critical in achieving desired clinical outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4145271-A4145271, November 12, 2024. A 42-year-old female with SLE, lupus cerebritis with related seizure disorder, and mesenteric venous thrombosis on warfarin initially presented for syncope. Acute stroke workup was negative, and syncope was attributed to possible brief seizure. Six months later, the patient was evaluated by cardiology for hypertension diagnosed during hospitalization. She reported no further syncope, but exam revealed a 3/6 holosystolic murmur. Subsequent TTE identified severe MR with primary MV degeneration and LVEF >60%. A TEE confirmed severe MR with myxomatous MV leaflets and moderate-sized nonmobile vegetations attached to the atrial side of A2 and P2 of the MV. Subsequent infectious workup including serial blood cultures were negative. The patient was diagnosed with non-bacterial Libman-Sacks endocarditis (LSE). Given a lack of symptoms and plan to resume immunosuppressive therapy and continue her anticoagulation (AC), surgical intervention was initially deferred with close follow-up.The patient continued to endorse worsening headaches and brain MRI revealed new chronic small ischemic strokes. One morning, the patient noted sudden aphasia and presented to the ED. Stroke workup revealed an acute ischemic stroke with total left M2 occlusion of her MCA, and she underwent thrombectomy. Cerebral angiogram further revealed FMD. Given ongoing embolic phenomena, likely from LSE, she underwent MVR with mechanical valve and LA appendage ligation and continued mycophenolate and warfarin. Two months postoperatively, the patient remained asymptomatic with normal prosthetic valve function and neurologic status. However, evaluation for extracranial FMD with CTA revealed interval development of PV vegetations. These lesions and moderate PR were confirmed on TTE.Discussion:While response to immunosuppressive therapy and AC has been reported to improve early-phase LSE, this patient continued to experience thromboembolic events resulting from LSE vegetations while on mycophenolate and warfarin. Despite continuing these therapies after MVR, she later developed PV vegetations and PR. Pulmonary valve involvement is rare in LSE, and development of new disease while on recommended medical therapy represents unusual disease progression.

Circulation, Volume 150, Issue Suppl_1, Page A4138915-A4138915, November 12, 2024. Introduction:Although extracranial major bleeding (EMB) is often transient and manageable with supportive care, there is concern that EMB may have a subsequent detrimental effect on CV outcomes. However, a causal relationship is unclear, because the association is often confounded by underlying disease and comorbidities. Clinical trial data for more comprehensive analyses via advanced modeling are limited.Research Question:What is the effect of rivaroxaban vs. warfarin on CV outcomes mediated through EMB?Aim:To determine the extent of the effect of rivaroxaban vs. warfarin on CV outcomes that is mediated through their differential impact on EMB using a novel, advanced modeling approach (EUPAS1000000168).Methods:Using 5 US observational databases from routine clinical practice (01-11-2010 to 31-12-2022), adult patients with non-valvular atrial fibrillation (NVAF) were identified to establish the target and comparator cohorts, with 1stexposure as index date. Treatment balance was achieved by matching on propensity scores derived from large-scale regularized regression. Cox proportional hazards models estimated the main effect on CV outcomes (myocardial infarction, ischemic stroke, and composite endpoint) for rivaroxaban vs warfarin, with target and comparator time-at-risk right-censored at therapy end or switch, event occurrence, or database observation end. The EMB mediation effect on outcomes was estimated by including EMB as time-varying covariate, while controlling mediator-outcome confounding by including a mediator risk score in the outcome model. Comparative analyses were conducted only when pre-specified diagnostics passed for covariate balance, equipoise, and systematic error estimated through negative controls.Results:In 5 databases, 378,384 rivaroxaban initiators were matched to 601,174 warfarin initiators with NVAF. Common comorbidities included hypertension, hyperlipidemia, coronary artery disease, and heart failure. Main effects and indirect effects (mediation effects) are in Table A.Conclusion:This analysis suggested that EMB had no impact on the effect of rivaroxaban vs. warfarin on CV outcomes. A limitation is that EMB occurrence and CV events after EMB were limited, which reduced mediation impact.

Circulation, Volume 150, Issue Suppl_1, Page A4139594-A4139594, November 12, 2024. Background:Studies related to the Watchman device generally report data at the 45-day, 6-month, 1-year, and 2-year intervals, with outcomes supportive of Watchman closure. The imaging of the device at 45 days is believed to coincide with substantial completion of device endothelization and the end of the high risk period for device related thrombus (DRT). Thus, prophylactic systemic anticoagulation (SA) is often discontinued at this time.Objective:To report the incidence of delayed DRT in patients following the 45 day post-implant imaging and the cessation of SA.Methods:In this single center retrospective study, we assessed patients undergoing Watchman device placement between April 16, 2016, and June 30, 2022. Patient data was retrieved from our institutional Cardiovascular Data Registry database. Following Watchman device implantation, all patients underwent a 45-day surveillance TEE or CT. Our primary interest was assessing the incidence and timing of delayed DRT and determining the anti-platelet and/or SA regimen at the time of DRT.Results:A total of 861 patients who underwent Watchman device placement were included in the study. The 45-day surveillance imaging revealed that 2.2% (19/861) of patients exhibited a DRT during the initial follow up imaging while on SA and aspirin (ASA). These patients continued on SA/ASA until the 6-month imaging, at which point 84% (16/19) patients showed DRT resolution. Among the 2 with persistent thrombus, one was on ASA/warfarin, while the other was on DAPT. The 3rd patient did not complete subsequent imaging after 45 days.The patients without DRT at 45-day imaging had a 0.83% (7/842) incidence of DRT with 42.9% (3/7) revealed at 6 month, 42.9% (3/7) revealed at 12 months and the remaining 14.3% (1/7) at 24 month imaging. SAPT/SA protection was in place in 57.1% (4/7) of these cases, while the remainder were on SAPT 28.5% (2/7), or nothing at all 14.3% (1/7). Alarmingly, 2/7 of these cases resulted in an ischemic stroke in the absence of SA. In 85% of cases, DRT was associated with peridevice leak.Conclusion:These findings underscore the importance of ongoing surveillance in patients with Watchman devices and do not suggest a clear association between continued anticoagulation therapy and reduced risk of delayed DRT formation. Further investigations are warranted to determine whether there are predictive patient or implant characteristics and elucidate optimal management strategies for this patient population.

Circulation, Volume 150, Issue Suppl_1, Page A4142147-A4142147, November 12, 2024. Introduction:The utilization of direct oral anticoagulant (DOAC) agents for atrial fibrillation (AF) in individuals with end-stage renal disease (ESRD) has increased despite a lack of robust supportive data from randomized controlled trials. We planned to assess the outcomes associated with rivaroxaban versus warfarin in the ESRD population with AF.Methods:We utilized the TriNetX Global Collaborative Network, which includes 114 Healthcare organizations to perform a propensity-score matched retrospective cohort study. We used ICD-10 codes to identify individuals with ESRD and AF, over 18 years of age, excluding those with prosthetic valves and apixaban or edoxaban use. Data were collected from 2011 to 2024. We evaluated the incidence of ischemic stroke (I63), intracranial hemorrhage (I62.9), cardiac arrest (I46), mortality, gastrointestinal (GI) hemorrhage (K92.2), systemic embolism and thrombosis (I74.3, I74.2), and other cardiac arrythmias (I49). We performed propensity-score matching (PSM) on age, sex, race, BMI,hypertension, diabetes mellitus, tobacco use, heart failure, stroke, or acute myocardial infarction.Results:We identified 25,092 individuals in the warfarin group and 2,391 individuals in the rivaroxaban group. After PSM, 2,381 individuals remained in each group. The average age was 72.9, predominantly male (59.8%), with 62.9% white, 14.7% African American, and 6.5% Hispanic individuals. Compared to those treated with warfarin, individuals treated with rivaroxaban demonstrated a lower risk of a composite outcome (Infarct, intracranial hemorrhage, mortality) (RR 0.823, 95% CI 0.765-0.885), mortality (RR 0.830, 95% CI 0.775-0.888), GI hemorrhage (RR 0.566, 95% CI 0.439-0.730), and cardiac arrest (RR 0.696, 95% CI 0.531-0.911). We found no significant difference in the risk of ischemic stroke (RR 1.024, 95% CI 0.744-1.408), intracranial hemorrhage (RR 0.587, 95% CI 0.270-1.280), systemic embolism (RR 0.828 (95% CI 0.512-1.339), or other cardiac arrythmias (RR 0.973, 95% CI 0.804-1.179).Conclusion:In individuals with AF and ESRD the use of rivaroxaban, in comparison to warfarin, was associated with a reduction in the risk of mortality, gastrointestinal hemorrhage, and cardiac arrest. We found no difference in other clinically relevant outcomes, including ischemic stroke. These findings suggest an extension of the safety benefits previously observed with DOACs to the ESRD population, however further research is needed to guide management.

Circulation, Volume 150, Issue Suppl_1, Page A4141755-A4141755, November 12, 2024. Background:Mechanical heart valve replacement (MHVR) is an effective method for the treatment of severe heart valve disease. However, it subjects patients to lifelong warfarin therapy after MHVR, with the attendant risk of bleeding and thrombosis. Whether internet-based warfarin management reduces complications and improves patient quality of life remains unknown.Objective:This study aimed to compare the effects of internet-based warfarin management and the conventional approach in patients who received MHVR in order to provide evidence regarding alternative strategies for long-term anticoagulation.Methods:This was a prospective, multicenter, randomized, open-label, controlled clinical trial with a 1-year follow-up. Patients who needed long-term warfarin anticoagulation after MHVR were enrolled and then randomly divided into conventional and internet-based management groups. The percentage of time in the therapeutic range (TTR) was used as the primary outcome while bleeding, thrombosis, and other events were the secondary outcomes.Results:A total of 721 patients were enrolled. The baseline characteristics did not reach statistical differences between the two groups, suggesting the random assignment was successful. As a result, the internet-based group showed a significantly higher TTR (mean 0.53, SD 0.24 vs. mean 0.46, SD 0.21; P < .001) and fraction of time in the therapeutic range (mean 0.48, SD 0.22 vs. mean 0.42, SD 0.19; P < .001) than did those in the conventional group. Furthermore, as expected, the anticoagulation complications, including bleeding and embolic events, had a lower frequency in the internet-based group than in the conventional group (6.94% vs. 12.74%; P = .01). Logistic regression showed that internet-based management increased the TTR by 7% (odds ratio [OR] 1.07, 95% CI 1.05-1.09; P < .001) and reduced the bleeding and embolic risk by 6% (OR 0.94, 95% CI 0.92-0.96; P = .01). Moreover, low TTR was found to be a risk factor for bleeding and embolic events (OR 0.87, 95% CI 0.83-0.91; P = .005).Conclusions:Internet-based warfarin management is superior to the conventional method, as it can reduce anticoagulation complications in patients who receive long-term warfarin anticoagulation after MHVR.

Circulation, Volume 150, Issue Suppl_1, Page A4144488-A4144488, November 12, 2024. Background:Oral anticoagulants (OAC) including Vitamin K antagonists such as warfarin and direct oral anticoagulants like Apixaban, Rivaroxaban, and Edoxaban, have long been the standard treatment for stroke prevention in patients with atrial fibrillation (AF). However, they increase the risk of bleeding, making them unsuitable for certain patient populations, particularly those with a personal history of bleeding, elderly individuals prone to falls or those with high-risk occupation with safety hazards. In cases of non-valvular AF, where thrombi typically form in the left atrial appendage, mechanical left atrial appendage closure (LAAC) has come out as an alternative for selected patients. Numerous studies have shown that LAAC is comparable to OAC in preventing strokes while significantly reducing major bleeding events. This meta-analysis aims to compare the 4–5-year outcomes of these two treatment strategies in non-valvular AF.Methods:4 studies (3 randomized controlled trials and 1 observational study) comparing the 4–5-year outcomes of LAAC versus OAC in patients with AF were included in this meta-analysis. These studies were identified after a thorough search of PUBMED, COCHRANE, and MEDLINE databases from inception till May 2024. The outcomes of interest were MACE (composite of stroke, embolism, and death), ischemic stroke, major bleeding episodes, cardiovascular (CV) deaths, and all-cause death. The results were reported as Risk Ratio (RR) with 95% confidence intervals (CI), using a random effects model.Results:6,012 patients were identified from the 4 studies. After a median follow-up of 4–5 years, LAAC was associated with a clinically significant reduction in MACE (RR: 0.76, 95% CI: 0.61-0.94, p=0.01), all-cause mortality (RR: 0.77, 95% CI: 0.62-0.96, p=0.02), and CV mortality (RR: 0.64, 95% CI: 0.45-0.90, p=0.01). Additionally, a significant reduction in major bleeding episodes (RR: 0.63, 95% CI: 0.44-0.91, p=0.01) was also noted between the two treatment strategies favoring LAAC treatment group. There was no significant difference in the incidence of ischemic stroke (RR: 1.07, 95% CI: 0.62-1.85, p=0.80) between the two groups.Conclusion:Over a median follow-up of 4-5 years, LAAC was found to be as effective as OAC in preventing ischemic strokes, while also showing lower incidence of MACE, all-cause, CV mortality and major bleeding episodes. More RCTs are needed to further assess the long-term outcomes between the two strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4147523-A4147523, November 12, 2024. Background:Pulmonary artery aneurysms (PAAs) are rare with an incidence of 1 in 14,000. While rare, they are very critical conditions with a mortality rate of 50-100%. PAAs may be congenital or acquired via infections, vasculitis, pulmonary arterial hypertension, chronic pulmonary embolism, inflammatory lung disease, neoplasm, or iatrogenic. The risk of PAA is due to respiratory compromise, compression of other structures, and dissection. We describe the rare presentation of a PAA with a concomitant ascending aortic aneurysm.Case Description:75-year-old woman with a PMH of hypertension, Group I pulmonary artery hypertension, HFpEF, non-obstructive CAD, aortic insufficiency s/p mechanical aortic valve replacement on warfarin since 02/2014, hyperlipidemia who was admitted due to altered mental status. Physical exam was remarkable for 4/6 diastolic murmur, 3/6 aortic murmur, prominent P2, and parasternal lift and no JVD or lower extremity edema. CXR incidentally showed enlarged pulmonary artery and CT chest showed PAA at 6.6 cm. Echocardiogram confirmed moderate to severe pulmonary hypertension and a markedly dilated PAA with pulmonary valvular insufficiency. In addition, she had an ascending aortic aneurysm with moderate aortic insufficiency. The two coinciding aneurysms could be distinct in etiology due to sequela of high pressure vessel wall degradation from pulmonary artery hypertension and systemic hypertension or related due to vasculitis or cystic medial necrosis/connective tissue disease. Due to multiple concomitant aneurysms, the patient is pending further workup.Discussion:Aneurysms are focal dilations with PAA larger than 29 mm and ascending aortic aneurysm larger than 44 mm. Common etiologies include vasculitis, connective tissue disease, and high vessel pressure. Due to the risk of fatal pulmonary hemorrhage, PAAs are critical. Diagnosis of PAA is via CTA and of aortic aneurysm is via TTE with annual monitoring. Surgical intervention is greater than 45-55 mm depending on risk factors for ascending aortic aneurysm and greater than 55 mm for PAA. Surgical interventions for PAAs include stent graft, aneurysmorrhaphy, lobectomy, aneurysmectomy, and pneumonectomy. Surgical resection comes with high risk in patients with severe pulmonary hypertension. Treating the underlying pulmonary artery hypertension is crucial to long term management along with determination and treatment of underlying cause.

Circulation, Volume 150, Issue Suppl_1, Page A4143844-A4143844, November 12, 2024. A 35-year-old gravida 1, para 0 with biventricular heart failure (LVEF 25%), nonischemic cardiomyopathy, history stroke, history of left ventricular thrombus, class III obesity, and chronic kidney disease who had been followed by Cardio-Obstetrics throughout her pregnancy presented at 34 weeks gestation for planned induction of labor. Upon presentation, she underwent assessment with a pulmonary artery catheter (PAC) and was noted to be in cardiogenic shock with elevated biventricular filling pressures and low cardiac index necessitating hemodynamic stabilization followed by primary cesarean section.The patient was admitted to the cardiac ICU for medical optimization prior to delivery. Home medications including isosorbide dinitrate, metoprolol, and hydralazine were continued. The patient was briefly placed on inotropic support with dobutamine, which was discontinued due to ectopy. After PAC-guided IV diuresis, anticoagulation transition from enoxaparin to heparin, and twice daily fetal monitoring via non-stress test, a multidisciplinary team, including cardiology, maternal fetal medicine, cardiac anesthesia, and cardiothoracic surgery assembled for the C-section. Following pre-delivery cannulation for potential ECMO support, the patient underwent C-section and elective salpingectomy under epidural anesthesia with delivery of a healthy neonate.Post-delivery, the patient was monitored in the ICU, focusing on fluid management, anticoagulation transition to warfarin, and titration of heart failure medications, as the patient did not plan to breastfeed. After discharge, she was scheduled for a 2-week postpartum visit including echocardiogram, EKG, and NT-proBNP.Discussion:Given the patient’s acute decompensation and fluid overload, medical optimization was essential prior to delivery. However, stabilization was expected to be temporary due to ongoing physiologic changes of pregnancy. Her limited mobility and concern for multiorgan compromise, such as new oxygen dependency and rising creatinine, made a prolonged induction of labor unfeasible. Due to concern for maternal intolerance of labor, unstable fetal lie, fetal distress due to decreased perfusion, and an increased likelihood of emergency C-section, a primary C-section was recommended as a safer option. The successful delivery of a healthy neonate and post-operative maternal stabilization highlights the importance of a multidisciplinary approach in managing complex cardio-obstetric cases.