Severe coarctation of the aorta diagnosed during pregnancy: the role of multimodal imaging and multidisciplinary approach to a complex subject—a case report

TL;DR

A pregnant woman with severe, uncontrolled high blood pressure was diagnosed with a rare heart condition called aortic coarctation and required early pregnancy termination followed by successful treatment.

Contribution

Highlights the importance of diagnosing aortic coarctation in pregnant women with refractory hypertension and the role of multidisciplinary decision-making.

Findings

Aortic coarctation should be considered in pregnant women with refractory hypertension due to significant maternal and fetal risks.

Pregnancy termination may be necessary in early-stage pregnancies with severe hypertension caused by aortic coarctation.

Successful treatment of aortic coarctation allowed a subsequent full-term pregnancy without major complications.

Abstract

Coarctation of the aorta (CoA) is a well-known congenital heart disease, which is often associated with other cardiac and vascular anomalies, most frequently a bicuspid aortic valve. Aortic coarctation is an unusual cause of hypertension during pregnancy, and its management is not clarified.

We report a case of a 24-year-old pregnant woman with long-standing hypertension, who presented at the end of the first trimester with severe refractory hypertension. The diagnostic investigation culminated in the diagnosis of a CoA. Facing risks for pursuing pregnancy such as aortic complications, hypertensive disorders, and foetal adverse outcomes, aside from limited therapeutic options and having in mind the relatively early stage in pregnancy, it was decided by multidisciplinary team and the patient for pregnancy interruption. After that, the patient was treated by percutaneous dilatation of aortic coarctation with stent implantation, with good results. Recently, the patient was able to carry out a newly full-term pregnancy without major incidents.

Coarctation of the aorta should be considered in pregnant women with refractory hypertension. It is associated with considerable risks to the mother and to the foetus. In cases presenting with refractory severe hypertension, termination of pregnancy needs to be considered, especially in first-trimester pregnancies.

This case also highlights the importance of investigating secondary causes of hypertension in young people, as these can often be treated, averting potentially severe complications.

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