Malignant pulmonary edema in a pregnant woman caused by cor triatriatum.

Abstract

Undiagnosed maternal congenital heart disease can result in significant risks to both mother and fetus. When maternal symptoms and signs are atypical of preeclampsia, broadening the differential diagnosis and multidisciplinary consultation can lead to improved outcomes. A 24-year-old primiparous woman with a pregnancy complicated by elevated blood pressure and proteinuria presented at term with symptoms of decreased fetal movement, increasing dyspnea, and cough. Her symptoms progressively worsened until she experienced cardiorespiratory arrest during attempted intubation. Emergency cesarean delivery was performed after 5 minutes of resuscitation efforts. Echocardiogram performed after delivery revealed cor triatriatum requiring surgical excision. A complete differential diagnosis for edema, hypertension, and dyspnea near term will allow for recognition of more rare conditions. Referral to cardiology in cases in which work-up is negative for preeclampsia may aid in earlier diagnosis and management. A team approach to management involving obstetrics and medicine will improve the rapidity with which rare conditions can be managed effectively.