Unrepaired Aortic Coarctation Diagnosed Late in Pregnancy: A Case Report Highlighting the Importance of Comprehensive Cardiovascular History

Abstract

Background: Coarctation of the aorta is a congenital cardiovascular lesion that may remain undiagnosed until adulthood. During pregnancy, the physiological increases in blood volume and cardiac output may worsen hypertension and increase the risk of maternal cardiovascular complications, particularly in women with severe or unrepaired disease. Aim: This case highlights the importance of comprehensive cardiovascular history-taking and coordinated multidisciplinary care. Case Presentation: We report the case of a 33-year-old gravida 2 para 1 woman with chronic hypertension and a previous caesarean delivery who was referred to a tertiary high-risk obstetric clinic at 26 weeks of gestation. At 37+3 weeks, she presented with severe-range blood pressure and disclosed a prior diagnosis of an aortic aneurysm made six years earlier. Computed tomography aortography demonstrated severe stenosis of the terminal aortic arch, with approximately 75–90% luminal narrowing and post-stenotic dilatation of the proximal thoracic aorta. Echocardiography confirmed aortic coarctation with preserved left ventricular systolic function. Following multidisciplinary review, urgent caesarean delivery with bilateral salpingectomy was performed. A live female neonate weighing 3080 g was delivered with Apgar scores of 9, 10, and 10. The neonate was assessed, and no identifiable cardiac anomaly was found. The mother remained clinically stable postoperatively under intensive monitoring and blood pressure control. Discussion: CoA is a lifelong congenital cardiovascular defect whose clinical presentation depends on the degree and length of narrowing of the aorta. It commonly presents with hypertension and is associated with a 20% risk of pre-eclampsia during pregnancy. It is managed by stenting or surgical repair. Women with repaired CoA have a 10–19% risk of a cardiac event during pregnancy, whereas those with severe unrepaired CoA have an extremely high risk of maternal mortality or severe morbidity and are therefore considered to have a contraindication to pregnancy. Vaginal delivery is generally safe in these women, with caesarean section reserved for standard obstetric indications. Conclusion: This case emphasises the importance of thorough cardiovascular history-taking and examination in pregnant patients with chronic hypertension. Women with congenital cardiac disease require preconception counselling, multidisciplinary antenatal care, individualised delivery planning, and close postpartum surveillance.