2008, Number 3
Med Crit 2008; 22 (3)
Report of a clinical case of pregnancy with aortic coarctation associated to severe preeclampsia
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ABSTRACTIntroduction: The aortic coarctation is a congenital cardiopathy, it can be discovered in adulthood. Clinically it is characterized by an arterial tension gradient manifested by bounding pulses in upper limbs, absented or decreased in lower limbs and compensating collateral circulation. This pathology presents high maternal morbidity during pregnancy, and it has reduced frequency of preeclampsia.
Presentation of the case: 25-year-old women, secundigravida, her first pregnancy ended in vaginal delivery. Thirty seven weeks pregnant in first stage of labor and ended in eutocic labor. Physiological puerperium, high arterial tensions in more than 48 hours with light vasospasm symptoms. Light edema in lower limbs. Jugular engorgement grade I, bounding pulses in upper limbs, absented in lower limbs, splitting of the second heart sound, IIP reinforced, systolic murmur at the aorta focus with neck vessels, suprasternal notch and left infraclavicular region irradiation. Arterial Tension: 180/110 mmHg. General Urine Examination: Proteinuria +++, Chest Tele X – Ray: Bilateral Roessler sign from the fifth to the eighth costal arches. Electrocardiogram: Heart rate: 80 bpm, incomplete left bundle-branch block, left ventricular hypertrophy, left auricular growth. Echocardiography: Left concentric hypertrophy, conserved ventricular and systolic function, trivalve aortic valve. Angiotomography: Aortic Coarctation in the distal third of the aortic arch. Treatment: Hydralazine, propanolol, hydrochlorothiazide, ampicillin, gentamicin.
Conclusion: The patient was referred to the third level for her cardiologic interventionist treatment. It is necessary to make the precocious diagnosis of these pathologies, and encourage the prebirth control in order to avoid serious complications.