C38. Diagnosis and Management of Atrial Septal Defects (ASD) and Pulmonary Hypertension (PH) in Pregnancy

Abstract

Abstract Background Atrial Septal Defect (ASD) is a congenital heart disease that is often found in adulthood, including women in pregnancy. Women with ASD are at greater risk for cardiovascular complications during pregnancy especially with Pulmonary Hypertension (PH), so comprehensive management is essential for this case. Case Summary A 31-year-old woman with gravida 32-33 weeks complaint of shortness of breath increasing since 3 days before entering the hospital with central cyanosis, clubbing finger, peripheral oxygen saturation 74%, from auscultation showed hardened P2 sound, indistinct wide fixed split, grade 3/6 systolic murmur. Echocardiography showed ASD with High Probability PH (Pulmonary Hypertension). The patient treated with furosemide 2x20 mg, sildenafil 3x12.5 mg, 3x20 mcg berraprost. The pregnancy was electively terminated with cesarean delivery and also got tubectomy. After 18 days of treatment in hospital, patient was discharged with stable and good condition. The patient was planned for right heart catheterization from outpatient clinic. Discussion Based on Guidline ESC on the management of Cardiovascular disease during Pregnancy in 2011, patients with ASD-PH are included in class IV WHO classification, where are contraindicated for pregnancy. If the pregnancy continues, recommended for patients to control regularly to the cardiologists and obstetricians during pregnancy, delivery and the puerperium. From literature, cesarean delivery is recommended for pregnant women with Pulmonary Hypertension (including Eisenmenger's Syndrome). Special attention and comprehensive management are required for pregnant patients with ASD-PH. The choice of intervention method and some medical therapy in this patient must also be considered.