Case report of a 26 year old primigravida with patent ductus arteriosus (PDA) in heart failure
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Published on: January 27, 2023
1Division of Cardiology, LAUTECH Teaching Hospital, Osogbo, Osun State Nigeria. iakintunde2@yahoo.com
Insights
Pregnancy can worsen congenital heart disease, especially undiagnosed conditions like patent ductus arteriosus (PDA). Early detection through careful examination is crucial for managing heart failure during pregnancy.
Area of Science:
- Cardiology
- Obstetrics
- Maternal-Fetal Medicine
Background:
- Congenital heart disease (CHD) poses significant risks during pregnancy, altering maternal and fetal physiology.
- Pregnancy exacerbates cardiac strain in women with CHD, increasing the risk of heart failure.
- Coexisting conditions like anemia and hypertension further compromise cardiac reserve.
Observation:
- Patent ductus arteriosus (PDA), a type of CHD, can manifest or worsen during pregnancy.
- Moderate to large PDAs cause volume overload, leading to left ventricular dilation and dysfunction.
- Pregnancy in women with hemodynamically significant PDA may precipitate or worsen heart failure.
Findings:
- A successful pregnancy was achieved in a 26-year-old primigravida with previously undetected PDA and preeclampsia who presented with heart failure.
- This case underscores the potential for PDA to present during pregnancy, leading to severe cardiac complications.
- Intensive maternal examination is vital for identifying undiagnosed cardiac conditions.
Implications:
- Highlights the critical need for thorough cardiac evaluation in pregnant patients.
- Emphasizes the importance of early diagnosis and management of PDA in pregnancy to prevent heart failure.
- Informs obstetric and cardiology practices regarding the risks and management of CHD during gestation.
Abstract:
Congenital heart disease is an important cause of maternal morbidity and mortality during pregnancy. Pregnancy alters the circulatory and respiratory physiology with attendant deleterious effect on the mother with congenital heart disease and the foetus. Additional insult to the circulatory physiology by other factors coexisting together with congenital heart disease can further reduce the cardiac reserve in pregnancy and precipitate heart failure. These factors include anaemia, thromboembolism, hypertension, multiple pregnancy, strenuous physical activity, extremes of temperature and the normal physiological edema of pregnancy.Patent ductus arteriosus (PDA) can present for the first time in pregnancy. Moderate to large PDA result in significant volume overload, left ventricular dilation and dysfunction. In the woman with a hemodynamically important PDA, pregnancy may precipitate or worsen heart failure. We report a successful pregnancy in a 26 year old primigravida with previously undetected patent ductus arteriosus with preeclampsia who presented in heart failure. This case highlights the importance of intensive careful examination of pregnant patients to identify such conditions.
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