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.