Management of Coarctation of the Aorta during Pregnancy: A Case Report.

Abstract

BACKGROUND: Patients with coarctation of the aorta are increasingly reaching child-bearing age. Unrepaired coarctations and/or repaired coarctations with recurrent or residual stenosis require close monitoring for hypertension and heart failure, which can increase maternal risk for aortic rupture or dissection and neonatal risks for intrauterine growth retardation, abruptio placentae, and premature delivery. The potential for adverse outcomes may necessitate repair during pregnancy. CASE: An 18-year-old primigravida at 11 weeks gestation with history significant for unrepaired coarctation of the aorta presented with chest pain for 2-3 days and nonpalpable lower extremity pulses. She was previously diagnosed with coarctation at age 3 years, which did not require surgical repair and she was subsequently lost to follow up. Echocardiogram (ECHO) showed a dilated ascending and transverse aorta with decreased pulsatility in the descending aorta, consistent with critical coarctation. Emergent cardiac catheterization was performed and a balloon expanded stent was used to dilate the area of coarctation. Post-procedurally she had zero gradient and went on to have an uneventful pregnancy and delivery. She is now a 23-year-old G5P3. She has two living children with Shone’s complex and had two pregnancies end in miscarriages. Fetal ECHO was performed for each pregnancy and the patient received genetic counseling but declined further genetic testing. CLINICAL SIGNIFICANCE: This case illustrates a successful percutaneous repair of coarctation during pregnancy via balloon expanded stent placement. Fetal ECHO should occur from 18-22 weeks gestation in pregnant women with history of coarctation as prevalence of left-sided obstructive lesions may occur in 10–20% of first-degree relatives. As shared cardiac genetic markers exist between coarctation and Shone’s complex, this case also demonstrates the impact prenatal genetic testing can potentially have on subsequent pregnancies and neonatal outcomes.