Undiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case report
Abstract 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 subac...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-10-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.12868 |
| _version_ | 1818431985300799488 |
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| author | Hendrik Thoen Lien Moreel Bert Adriaenssens Siegmund Keuleers Joeri Voet |
| author_facet | Hendrik Thoen Lien Moreel Bert Adriaenssens Siegmund Keuleers Joeri Voet |
| author_sort | Hendrik Thoen |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-14T15:58:00Z |
| format | Article |
| id | doaj.art-01f712a7a5144780b56a4365839c338b |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-14T15:58:00Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-01f712a7a5144780b56a4365839c338b2022-12-21T22:55:13ZengWileyESC Heart Failure2055-58222020-10-01753193319710.1002/ehf2.12868Undiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case reportHendrik Thoen0Lien Moreel1Bert Adriaenssens2Siegmund Keuleers3Joeri Voet4Department of Cardiology AZ Nikolaas General Hospital Moerlandstraat 1 Sint‐Niklaas B‐9100 BelgiumDepartment of Cardiology AZ Nikolaas General Hospital Moerlandstraat 1 Sint‐Niklaas B‐9100 BelgiumDepartment of Cardiology AZ Nikolaas General Hospital Moerlandstraat 1 Sint‐Niklaas B‐9100 BelgiumDepartment of Cardiology AZ Nikolaas General Hospital Moerlandstraat 1 Sint‐Niklaas B‐9100 BelgiumDepartment of Cardiology AZ Nikolaas General Hospital Moerlandstraat 1 Sint‐Niklaas B‐9100 BelgiumAbstract 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.https://doi.org/10.1002/ehf2.12868Adult congenital heart diseaseAortic coarctationPatent ductus arteriosusAcute heart failurePostpartum hypertensionPostpartum dyspnoea |
| spellingShingle | Hendrik Thoen Lien Moreel Bert Adriaenssens Siegmund Keuleers Joeri Voet Undiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case report ESC Heart Failure Adult congenital heart disease Aortic coarctation Patent ductus arteriosus Acute heart failure Postpartum hypertension Postpartum dyspnoea |
| title | Undiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case report |
| title_full | Undiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case report |
| title_fullStr | Undiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case report |
| title_full_unstemmed | Undiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case report |
| title_short | Undiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case report |
| title_sort | undiagnosed adult congenital heart disease presenting with postpartum dyspnoea a case report |
| topic | Adult congenital heart disease Aortic coarctation Patent ductus arteriosus Acute heart failure Postpartum hypertension Postpartum dyspnoea |
| url | https://doi.org/10.1002/ehf2.12868 |
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