Pulmonary arterial hypertension associated with congenital heart disease after defect repair: the effect of pregnancy

• Published in: Journal of Congenital Cardiology Vol. 4; no. S1; p. 1
• Main Authors: Brida, Margarita, Favoccia, Carla, Constantine, Andrew, Dimopoulos, Konstantinos
• Format: Journal Article
• Language: English
• Published: London BioMed Central 16.12.2020
• Subjects: Cardiology; Cardiovascular disease; Congenital diseases; Connective tissue diseases; Drug dosages; Heart; Hemodynamics; Medical diagnosis; Nitric oxide; Pathophysiology; Patients; Pregnancy; Pulmonary arteries; Pulmonary hypertension; Task forces; Transplants & implants
• ISSN: 2056-7251; 2056-7251
• DOI: 10.1186/s40949-020-00046-8

Abstract Background An increasing number of patients with previously repaired congenital heart disease (CHD) present with pulmonary arterial hypertension (PAH). This can occur immediately after repair (residual PAH) or years later. Case presentation We present the case of a young woman who underwent repair of a ventricular septal defect in later childhood. Three years after repair, she was found to have significant residual PAH. She remained stable on PAH therapies, but a decade later decided to become pregnant against medical advice. She deteriorated during pregnancy and required escalation of PAH therapies and eventual admission to the intensive care unit, with an uneventful delivery at 32 weeks. Despite successful delivery, she remained symptomatic post-partum, with evidence of disease progression at right heart catheterisation. Conclusions All patients with repaired CHD should undergo routine screening for PAH. Early diagnosis and expert management, including the use of PAH therapies, is recommended to optimise outcome. Pregnancy is contraindicated in PAH patients, including patients with CHD, and requires an expert multidisciplinary approach to reduce morbidity and mortality when patients opt to proceed.