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Pregnancy with coarctation appears low risk overall but individual cardiovascular evaluation remains essential
  1. Rachael Cordina1,
  2. Wei Li2,3
  1. 1Department of Cardiology, Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  2. 2Adult Congenital Heart Disease and Echocardiography, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  3. 3Cardiovascular Imaging, National Heart and Lung Institute, Imperial College, London, UK
  1. Correspondence to Dr Wei Li, Adult Congenital Heart Disease and Echocardiography, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; W.Li{at}rbht.nhs.uk

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Coarctation of the aorta (figure 1A and B) accounts for around 5% of congenital heart defects1 and is frequently associated with a generalised arteriopathy. The natural course of the disease is varied and depends on coarctation severity as well as associated comorbidities and cardiac defects, which are common. Coarctation-related cardiovascular complications may include, inter alia, systemic hypertension, left heart diastolic dysfunction(figure 1C), intracranial haemorrhage (from an associated berry aneurysm), aortic rupture/dissection, premature coronary and cerebral artery disease. In recent decades, surgical and percutaneous interventions for coarctation of the aorta have been established with good long-term results.2 The morbidity after surgical repair and interventional balloon dilatation or stenting remains largely related to aortic complications and long-standing hypertension.

Figure 1

Risk factors for women with coarctation considering pregnancy beyond heart failure. CW, continuous wave; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

Pregnancy is associated with increased haemodynamic demands, hormone-related connective tissue changes as well as other neurohormonal alternations that may adversely affect women with aortic pathology and/or other congenital heart defects. The outcome of pregnancy in women with coarctation of the aorta has been reported in a small number of case reports and case series. Population-based data from the USA have suggested that pregnancy in women with coarctation of the aorta is associated with higher rates of cardiovascular morbidity and caesarean section, longer inpatient stays and higher inpatient costs.3 Women with an arm-to-leg blood pressure difference of <20 mmHg after coarctation repair are considered to have mild degree of pressure afterload and in them, pregnancy has …

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Footnotes

  • Contributors Both authors contributed equally to drafting the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

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