chief internal medicine of second level hospital IMSS san luis potosi, San Luis Potosi, Mexico
Background: Uncorrected atrial septal defect (ASD) can lead to severe pulmonary hypertension (pHTN) and shunt reversal. Pregnancy in a patient with pHTN carries a high risk with fetal and maternal mortality. Even after successful delivery, acute RV failure and paradoxical embolism occur. As such, current guidelines advise against pregnancy.
Methods: Data is obtained from the work institution
Outcome: A 27-year-old woman with history of heart murmur since childhood. Second pregnancy, an echocardiogram was performed at 20 weeks of gestation, with verified AIC and PAH without follow-up in the rest of the pregnancy, TAPSE 21 mm. She presented at 37 WOG and active labor with acute heart failure syndrome. An electrocardiogram was performed showing sinus tachycardia, RV growth plus RV systolic overload. A portable echocardiogram Reporting Left ventricle with borderline LVEF of 53% with diastolic collapse of the LV. Dilated right ventricle and atrium with a 2.5 cm atrial septal defect without borders, left-to-right short circuit. PSAP 62 mmHg. TAPSE 21 mm TAPSE/PSAP INDEX 0.45, right ventricular failure is concluded, with severe pulmonary hypertension. Preload increase with crystalloid is started to improve LV collapse, management with the inodilator Levosimendan is started with the primary objective of improving RV and LV function in addition to a decrease in PVR and a decrease in PSAP. After hemodynamic stabilization, the patient was admitted for pregnancy termination via abdominal. The outcome was successful. Maintaining hemodynamic stability, spontaneous ventilation with O2 support 3 liters per minute. The patient was transferred to the intensive care unit for surveillance of the surgical-pathological puerperium.
Conclusion: Pregnancy in patients with congenital heart disease and severe HPTN is at high risk and needs close monitoring. Scheduled cesarean section, is usually performed between weeks 32-36. In the case of our patient, who was not under medical treatment, aggressive management and a multidisciplinary approach led to a positive outcome.
