Hepatic ischemia associated with coarctation of the aorta in pregnancy: key issues in differential diagnosis.
BACKGROUND
Hepatic ischemia associated with coarctation of the aorta has not previously been reported in an adult; pregnancy increases the pressure gradient across a coarctation.


METHODS
A young woman with known coarctation of the aorta developed severe hepatic ischemia in pregnancy. A pregnancy-induced increase in the mean pressure gradient across the coarctation, from 18 mm Hg before pregnancy to 40 mm Hg in the third trimester, predisposed to critical hepatic hypoperfusion in the setting of dehydration.


CONCLUSIONS
This case documents an association between coarctation of the aorta and hepatic ischemia, precipitated by pregnancy and dehydration in combination. It emphasizes the need in the assessment of patients with liver disease in pregnancy to consider not only "traditional" pregnancy-related conditions such as acute fatty liver and the hemolysis, elevated liver enzymes, low platelets syndrome, in which delivery may be necessary as a clinical emergency, but also those in which the circulatory and metabolic demands of pregnancy may precipitate liver injury.
Webster
George J M
GJ
Gastrointestinal and Liver Unit, The Prince of Wales Hospital, and Royal Hospital for Women, Sydney, Australia.
Kurtovic
Jelica
J
Lowe
Sandra A
SA
Riordan
Stephen M
SM
D000328:Adult; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D047109:Fetal Development / Q000502:physiology; D005500:Follow-Up Studies; D005865:Gestational Age; D017359:HELLP Syndrome / Q000175:diagnosis*; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000175:diagnosis*; D008099:Liver / Q000098:blood supply*; D008111:Liver Function Tests; D008991:Monitoring, Physiologic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D012720:Severity of Illness Index