Abstract
An 18-year-old primigravida was admitted in the seventh month of pregnancy with a diagnosis of pre-eclampsia, based on a recent rise of the blood pressure up to 175/110 mmHg. Oedema and proteinuria were absent. Examination revealed absent femoral pulses and no measurable blood pressure in the lower limbs. A harsh holosystolic murmur, grade 4, was audible over the pre-cordium. A collateral pulse was felt at the medial border of the left scapula. The chest film showed rib erosions and a possible widening of the ascending aorta. A diagnosis was made of aortic coarctation with probable aortic aneurysm. To avoid the strain of labour a Caesarean section was successfully undertaken. Subsequent aorto-angiography showed the presence of a marked aortic coarctation, an aneurysm of the ascending aorta and markedly dilated innominate, left subclavian and mammary arteries. Surgical repair was undertaken eight weeks after delivery. The aortic stenosis had a diameter of only 3 mm. Histologic examination of the removed specimen revealed marked atheromatosis, intimal fibrosis and mucoid degeneration. The findings thus justified the therapeutic procedure selected. The diagnosis of aortic coarctation is reviewed and the management when found during pregnancy is discussed.