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Pregnancy and cardiovascular disease: the role of multimodal imaging and multidisciplinary approach
Session:
Sessão Melhores Casos Clínicos
Speaker:
Ana Débora Câmara de Sá
Congress:
CPC 2024
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
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Session Type:
Prémios, Registos e Sessões Especiais
FP Number:
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Authors:
Ana Débora Câmara De Sá; João Adriano Sousa; Francisco Sousa; Gonçalo Abreu; Bruno Silva; Filipa Reis; Mariana Lemos; Rui Anjos; António Drumond
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We present the case of a 24-year-old pregnant woman with a previously known history of hypertension since adolescence and Graves disease, having undergone thyroidectomy 2 years ago. She was under antihypertensive medication and levothyroxine. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">10 weeks in pregnancy, she presents with difficult control hypertension. At 11 weeks of pregnancy, despite complying with medication (nifedipine 30mg bid and methyldopa 500mg bid), she continued to have uncontrolled blood pressure values, although asymptomatic. Aside from hypertension, the physical examination was unremarkable. As no records of secondary hypertension workup was found, we asked for 24-hour urinary metanephrines and cortisol, ECG and transthoracic echocardiogram. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The 24-hour urine test and the ECG were normal. The transthoracic echocardiogram showed a coartation at the descending thoracic aorta with maximum gradient 63mmHg. Additionally, a bicuspid aortic valve was observed without functional impact, along with a dilated ascending aorta and mild concentric hypertrophy of the left ventricle with preserved ejection fraction.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The thoracic angioCT confirmed the aortic coarctation, 15mm distal from origin of left subclavian artery, with 3mm of caudal extension, and 16, 9 and 23mm of luminal diameter before, at coarctation site and after, respectively. AngioCT of the brain excluded arteriovenous malformation. Bicuspid aortic valve is the most common congenital cardiovascular anomaly, occurring in 1–2% of the population, associating frequently with aortic coarctation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The sensitive and complex nature of these findings motivated a multidisciplinary approach where obstetrics, adult and pediatric cardiology colleagues deliberated on the risks of pursuing pregnancy, and the best options for treatment. It should be noted, that unrepaired severe coarctation conveys a very high risk of maternal comorbidity and mortality, ascending to 40-100% - mWHO IV, and interruption should be considered (not to mention the additional role of bicuspid valve and dilated ascending aorta - mWHO III). Facing these findings, concerns such as aortic complications (rupture or dissection), fetal growth restriction and spontaneous fetal loss, were acknowledged by both medical team and patient, and pregnancy interruption pursued. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">After that, the patient was treated by percutaneous dilatation of aortic coartation with stent implantation with a good angiographic and hemodynamic results. She was discharged 2 days after, sustaining normal blood pressure without the need for any antihypertensive medication. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Recently, the patient was able to carry out a newly full-term pregnancy without major incidents and is currently the mother of a newborn.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">It is essential to draw attention to health care providers to the need of investigating secondary causes of hypertension in young people, as these can often be treated, averting potentially severe complications.</span></span></p>
Slides
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