Open AccessUndiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case report
Author(s) -
Thoen Hendrik,
Moreel Lien,
Adriaenssens Bert,
Keuleers Siegmund,
Voet Joeri
Publication year - 2020
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.12868
Subject(s) - medicine , heart failure , ductus arteriosus , asymptomatic , pulmonary artery , heart disease , pulmonary hypertension , cardiology , pulmonary embolism , postpartum period , pulmonary angiography , pediatrics , pregnancy , surgery , biology , genetics
Patients with adult congenital heart disease are born with structural heart defects who survived into adulthood. Occasionally, complex lesions remain undiagnosed, potentially causing substantial cardiovascular health problems at young age. Here, the case is presented of a patient with subacute heart failure 1 week postpartum, revealing the diagnosis of aortic coarctation (CoA) with patent ductus arteriosus (PDA). A 34‐year‐old woman presented to the emergency department with severe hypertension and exercise‐related dyspnoea 1 week postpartum. An initial diagnosis of pulmonary embolism was made after detection of a solitary opacity in the pulmonary artery (PA) on CT pulmonary angiography. Symptoms persisted despite anticoagulant treatment. Thorough clinical and echocardiographic reassessment unmasked the diagnosis of severe CoA with PDA, which was treated with percutaneous dilatation and stenting. Follow‐up consultation 4 weeks later showed an asymptomatic patient with normalized blood pressure. The puerperium is a high‐risk period to develop hypertensive heart failure for mothers with pre‐existing heart disease, due to mobilization of extracellular fluid to the intravascular compartment. Undiagnosed CoA should always be ruled out in case of unexplained postpartum hypertension. When detecting a solitary opacity in the PA, a PDA with associated heart defects should be excluded by further investigations. This opacity is located at the orifice of the PDA in the PA and is probably a flow effect, which results from the mix of contrast‐free with contrast‐rich blood.