A Pregnant Woman With Severe Pulmonary Hypertension Due to an Atrial Septal Defect That Was Triggered by Pregnancy

Abstract Background: Pregnancy is contraindicated in patients with pulmonary hypertension (PH). Here, we report a case of a pregnant woman with severe PH due to an atrial septal defect (ASD) that was triggered by pregnancy.Case Presentation: A 27-year-old woman with gravida 3 and para 2 presented with dyspnea in the fifth or sixth month of pregnancy, which gradually worsened. At 35+4 weeks of gestation, echocardiography revealed a transtricuspid pressure gradient (TRPG) of 120 mmHg, a sign of right heart failure; thus, she was diagnosed with severe PH. Because it was unsafe to continue pregnancy, an elective cesarean section was performed at 35+6 weeks under general anesthesia. A female infant weighing 1880 g was delivered; her Apgar scores were 8 and 9 after 1 and 5 minutes, respectively. Intraoperative transesophageal echocardiography revealed an ASD in the mother’s heart, a possible cause of PH. After the delivery, the mother was treated with an epoprostenol infusion via Hickman line, which was continued, along with home oxygen therapy, after she was discharged from the hospital. Nine months later, she underwent transcatheter closure for the ASD and her PH resolved. Conclusion: In pregnant patients with PH, the baby should be delivered at the appropriate time to relieve the pressure on the patient’s hemodynamics. This should be followed by strict circulation management including the requisite medical and surgical interventions to restore cardiac function.