28-year-old delivers child despite rare heart condition with narrowed arteries

The patient had constant high blood pressure and also unequal blood pressure pulse in both her arms. She was further diagnosed with Coarctation of Aorta — a birth defect in which a part of the aorta is narrower than usual and was advised against continuation of pregnancy as it was life threatening.

In her ninth month of pregnancy, her condition suddenly deteriorated. She was immediately rushed to the emergency ward of Wockhardt Hospitals Mira Road where her treating doctor, Dr Rajashri Tayshete Bhasale, Consultant Gynaecologist and Obstetrician, Laparoscopic Surgeon, took charge. “The blood pressure in her right arm was 190/110 and left arm was 120/90. The differential reading was due to Takayasu Arteritis. Despite being on antihypertensive medication, her leg pulses were absent. Her ECHO showed severe Coarctation of Aorta with Mitral Regurgitation (a type of heart valve disease in which the valve between the left heart chambers doesn’t close completely, allowing blood to leak backward across the valve.),” she says.

Doctors had to perform a lower segment Caesarean section along with the cardiac anaesthesia team. “But she was kept under observation due to life-threatening associated complications such as stroke, sudden death and cardiac failure. During the post-surgery period, the patient was monitored in the ICU but it was uneventful. Delivery in this condition is always complicated but the patient responded well,” says Dr Bhasale.

Dr Mayuresh Pradhan, Consultant Cardiovascular and Thoracic Surgeon, explains that she had a significant narrowing of the main artery which supplies the lower part of the body. As a result, the lower body gets reduced blood supply. “Generally, patients are advised termination of pregnancy when having such a condition but this patient decided to continue the pregnancy. Such patients require Caesarean section and cannot have a normal vaginal delivery. The anaesthesia is challenging and requires monitoring of upper and lower limb pressure simultaneously in order to maintain good lower body perfusion. Such patients can land up with heart failure once the baby is delivered. But our patient made it through,” says he.

The problem with Takayasu’s Arteritis is that it is often unidentifiable. According to Mayo Clinic, “If you don’t have symptoms, you may not need treatment. But most people with the disease need medication to control inflammation in the arteries and prevent complications. Even with treatment, relapses are common, and your symptoms may come and go.”