Anesthetic Management of Severe Uncorrected Coarctation of Aorta for Cesarean Delivery in a Pregnant Woman with Preeclampsia and Twin Gestation: A Case Report

Coarctation of the aorta (CoA) is a rare but high-risk congenital cardiac disease which can complicate pregnancy by leading to heart failure, aortic dissection, or rupture. The hemodynamic stress of a twin pregnancy and concurrent severe preeclampsia significantly increases the risk of maternal and fetal morbidity. We report a 28-year-old primigravida at 33 weeks of gestation with dichorionic diamniotic twins, referred from outside hospital with severe CoA diagnosed at 20 weeks of gestation. Echocardiography revealed a 5 mm aortic narrowing and a bicuspid aortic valve. She had an uneventful antenatal course, but at 33 weeks of gestation, the patient presented with NYHA Class III dyspnea. She was scheduled for an elective cesarean section in view of the development of signs of early onset severe preeclampsia. Here, we discuss the anesthetic challenges encountered and the successful perioperative management of uncorrected severe CoA in complex obstetric situations.