Key result
Aortic coarctation surgery at 22 weeks gestation normalizes maternal BP and yields a healthy birth.
Why the study?
Does surgical correction of severe coarctation of the aorta in a pregnant patient with an ascending aortic aneurysm improve maternal and fetal outcomes?
Case Report (n=1)
Does surgical correction of severe coarctation of the aorta in a pregnant patient with an ascending aortic aneurysm improve maternal and fetal outcomes?
Surgical correction of severe aortic coarctation during the second trimester of pregnancy can successfully manage maternal hypertension and improve fetal blood flow without aneurysm expansion.
Case report suggests mid-gestation coarctation repair may be feasible in select patients; leaves open need for prospective safety data.
A pregnant patient presented at 21 weeks of gestation with severe coarctation of the aorta and a large aneurysm (5.4 cm) of the ascending aorta. The patient developed hypertension at gestation week 17. Continuous Doppler wave velocimetry showed a low systolic/diastolic (S/D) ratio in the uterine arteries indicating reduced blood flow to the placenta. The presence of a severe coarctation, aneurysm of the ascending aorta, and hypertension associated with the hemodynamic changes of pregnancy, increases maternal and fetal risk. The literature reviewed disclosed that aneurysm expansion and dissection or rupture on the one hand, and fetal demise on the other, are the greatest risks. The challenge of treating both the patient and the fetus was managed successfully by correction of the coarctation at week 22. Blood pressure normalized a few weeks after the operation, and no expansion in aneurysm diameter was noticed. A normal S/D ratio in the uterine arteries indicated increased blood flow in the uterine arteries. A healthy female was born. Pregnant patients with coarctation of the aorta should have surgical correction preferably in the first or second trimesters.
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Kupferminc et al. (1993) conducted a case report in Severe coarctation of the aorta and a large aneurysm of the ascending aorta in pregnancy (n=1). Surgical correction of the coarctation was evaluated on Maternal and fetal outcomes (blood pressure, aneurysm diameter, uterine artery blood flow, birth outcome). Surgical correction of severe aortic coarctation at 22 weeks of gestation successfully normalized maternal blood pressure, prevented aneurysm expansion, and resulted in the birth of a healthy female.
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