During her routine initial (first trimester) pre-natal evaluation, your patient, a 34-year-old primigravida female was discovered to have an abnormal ECG. She was sent to a cardiologist for further evaluation. She denied chest pain, weakness, palpitations, syncope, and shortness of breath, but she did state that she experienced occasional atypical chest pain when she was stressed and had a history of mitral valve prolapse. The patient was very active and exercised frequently.
On physical examination, she appeared alert and in no distress. Lungs were clear on auscultation. BP was 145/81 mm Hg, with a pulse of 90 beats per minute. Bilateral carotid bruits were heard, with the left sounding harsh. A soft systolic murmur was noted along the left sternal border and at the apex; the murmur appeared to radiate to the left carotid artery. The initial chest radiograph was normal.
The cardiologist performed an echocardiogram, which demonstrated mild mitral regurgitation and mild to moderate tricuspid regurgitation. There was no evidence of aortic valvular stenosis or subaortic stenosis. The cardiologist then decided to order a CT angiography (CTA) of the aorta to rule out supravalvular aortic stenosis, coarctation of the aorta, or other congenital aortic abnormalities. The reconstructed CTA images (see above) demonstrate narrowing of the proximal aspect of the aorta between the origins of the left common carotid artery and the left subclavian artery. These findings are compatible with coarctation of the aorta.
1-What exactly will you tell your patient about her condition and what are your specific concerns about her treatment options at this time?