CASE REPORT
A 31-year-old woman, (gravida 1, para 0) was referred to our department
at 37 weeks’ gestation for evaluation after ultrasound suspicion of
coarctation of the aorta. Until that moment the pregnancy was
uncomplicated, and the morphological fetal scan at 20 weeks showed no
abnormalities. 2-D echocardiography showed an enlarged dilated
structure, 14 mm in diameter, that protruded leftward of the aortic
arch. 4-D STIC ultrasound showed a turbulent, swirling flow within the
aneurysm with no restrictive aspect of the Doppler ductal flow at that
time (Figure 1). No other fetal structural anomalies were observed.
A female infant was born at 40 weeks’ gestation weighted 3.170 gr, with
an Apgar score of 10 and 10 at 1 and 5 minutes respectively. Physical
examination was normal. Neonatal echocardiography confirmed the presence
of a DAA on the left of the left side of the pulmonary artery (Figure
2). A thrombus was also identified in the ductus (arrow) with
hypertrophy of the right ventricle (RV). Follow-up echocardiograms
revealed a left-to-right shunt through the ductus, from the aorta to the
pulmonary artery, with stability of the thrombus. A conservative
approach was adopted with clinical and echocardiographic surveillance
with good outcome and spontaneous ductus closure at 3 days. The infant
is now asymptomatic at twenty months of life.