Our objective is to
endorse the management of women having atrial septal aneurysm ASA in pregnancy.
Diagnosis of ASA is disingenuous with pregnancy as its clinical picture is
similar to a wide range of normal pregnancy complaints. There were no clear
guidelines about management of such condition during pregnancy as well as the
literature. Thus, we tried to highlight our experience with what seems to be a
considerable cardiac disorder. Hereby, we report a case of a woman in her early
third trimester of pregnancy who presented with chest tightness and shortness
of breath. On examination, there was irregular tachycardia and her echocardiography
showed atrial septal aneurysm with mitral regurgitation. Multidisciplinary team
management was initiated during pregnancy till uneventful delivery. Regular
follow-up with monthly echocardiography, control of arrhythmia and thromboprophylaxis
were the corner stone for safe motherhood in such case.
Keywords: Atrial aneurysm;
septal aneurysm; arrhythmia; complicated pregnancy.
19 years old primigravida presented at 28 weeks’ gestation to her
routine antenatal clinic appointment in Benha University Hospitals complaining
of chest tightness and shortness of breath. Her pulse was irregular and
reaching 130 bpm. Otherwise her other vital signs were stable. Abdominal
examination revealed soft and lax gravid uterus with fundal height
corresponding to her dates and audible foetal heart beat. There was good
perception of foetal kicks and no gush of fluid or vaginal bleeding. Her
ultrasound showed single living healthy foetus with to date biometric and
The woman was referred immediately to emergency unit where she was
reviewed by senior cardiologist. Initially, her electrocardiography was showing
no abnormalities, but her echocardiography discovered the presence of
non-mobile atrial septal aneurysm towards the right side without visible
thrombosis or shunt at the trans-thoracic echocardiogram level. Her atrial
dimension, ventricular dimensions and valves were normal and no segmental wall
motion abnormalities could be detected at rest. Beta-blockers and aspirin were
prescribed to the woman. There was a strong family history of cardiac lesions
and she had a sister who died from a congenital heart defect.
The case was followed up on weekly outpatient basis as a high risk case.
Her echocardiography was repeated at monthly intervals. At 36 weeks’ gestation,
it showed extra findings as prolapsed anterior mitral valve leaflet with
moderate to severe mitral regurgitation was detected with normal other valves.
Also, her left ventricular dimensions were dilated with mild systolic
dysfunction. The recommendation by cardiologist included that as long as she
was haemodynamically stable and showed no signs of arrhythmias or thrombosis,
she can go for spontaneous vaginal delivery or caesarean section according to
obstetric decision with appropriate timing and dose of thromboprophylaxis. Aspirin
was stopped at the same visit.
Senior anaesthetist carefully reviewed the case and decided that she is
candidate for general or regional anaesthesia whenever needed and applicable.
She was delivered by caesarean section at 39 weeks’ gestation as she started to
have labour pains and progressive cervical dilatation with breech presentation.
Her postoperative follow-up was uneventful and she was discharged home on day
three after the procedure. Thromboprophylaxis started 12 hours postoperative
and continued till six weeks postpartum. After puerperium she started to follow
up with cardiology clinic.