Aortic Coarctation and Pregnancy

Abstract

An 18‐year‐old primigravida was admitted in the seventh month of pregnancy with a diagnosis of pre‐eclampsia, based on a recent rise of the blood pressure up to 175/110 mmHg. Oedema and proteinuria were absent. Examination revealed absent femoral pulses and no measurable blood pressure in the lower limbs. A harsh holosystolic murmur, grade 4, was audible over the pre‐cordium. A collateral pulse was felt at the medial border of the left scapula. The chest film showed rib erosions and a possible widening of the ascending aorta. A diagnosis was made of aortic coarctation with probable aortic aneurysm. To avoid the strain of labour a Caesarean section was successfully undertaken. Subsequent aorto‐angiography showed the presence of a marked aortic coarctation, an aneurysm of the ascending aorta and markedly dilated innominate, left subclavian and mammary arteries. Surgical repair was undertaken eight weeks after delivery. The aortic stenosis had a diameter of only 3 mm. Histologic examination of the removed specimen revealed marked atheromatosis, intimal fibrosis and mucoid degeneration. The findings thus justified the therapeutic procedure selected. The diagnosis of aortic coarctation is reviewed and the management when found during pregnancy is discussed.

Complement and Complement Components in Acquired Hemolytic Anemia with High Titer Cold Antibodies

“…Digital plethysmography showed complete circulatory arrest at 14" C, the Pariseus' phenomenon was present, and no cold vasodilatation could be produced by further cooling of the hands. These circulatory responses are caused by high-titer cold hemagglutinins and are different from those of patients with Raynaud phenomena of other etiology (6).…”

Anaesthetic management of aortic coarctation in pregnancy

“…2 This risk is most frequent in the third trimester, with no reported cases in labour itself. 8,9 Theoretically, the use of b-adrenergic blockade may reduce the risk of aortic rupture by decreasing the haemodynamic stress on the aortic wall. 2 In addition, poorly controlled hypertension may precipitate rupture of an associated intracranial aneurysm.…”

Pregnancy and Coarctation of the Aorta

“…The placenta is not subjected to the hypertension or its damaging effects, and whether reduction of maternal pressure above the coarctation reduces flow to the placenta is unknown. Hillstad (1972) used reserpine hydrallazine and chlorthalidone in one case when the infant was reported as normal but initially cyanosed. Recent evidence (Gallery et al, 1979) suggested that oxprenolol may reduce the incidence of intrauterine growth retardation associated with hypertension in pregnancy.…”