Pregnancy complicated by left ventricular mural thrombus in a hypertensive patient with autosomal dominant polycystic kidney disease and previous myocardial infarction.

Pregnancy in women with autosomal dominant polycystic kidney disease (ADPKD) complicated by significant cardiovascular disease is high risk. We report a multiparous woman in her late 30s with ADPKD, chronic hypertension and prior anterior wall myocardial infarction who was found to have a left ventricular mural thrombus at 12 weeks' gestation. She was managed with anticoagulation, pregnancy-adjusted antihypertensive therapy and multidisciplinary care. Fetal growth restriction developed at 32 weeks, and emergency caesarean delivery was performed at 35 weeks for absent end-diastolic flow in the umbilical artery. A live infant was delivered with good neonatal outcome. The mother had an uncomplicated postpartum recovery, and follow-up echocardiography showed partial thrombus resolution. This case highlights the complex interaction between ADPKD, cardiovascular disease and pregnancy and underscores the importance of individualised anticoagulation, strict blood pressure control and coordinated multidisciplinary management to optimise maternal and fetal outcomes.