Fetomaternal Outcomes in Late Presentation of Large Unrepaired Ventricular Septal Defect with Pulmonary Arterial Hypertension: A Case Report

Introduction Congenital Heart Disease complicates about 1% of pregnancies worldwide. In sub-Saharan Africa, limited access to paediatric cardiac surgery creates a group of "natural survivors" who often first present during pregnancy. Ventricular septal defects associated with pulmonary arterial hypertension pose significant maternal mortality risks, often exceeding 28%. Case presentation A 20-year-old primigravida at 37 weeks of gestation presented with false labour and New York Heart Association Class III heart failure symptoms. Echocardiography revealed a large 1.7-cm perimembranous ventricular septal defect with moderate pulmonary arterial hypertension, with right ventricular systolic pressure of 56 mmHg, classifying her as modified World Health Organization Class IV. Despite multidisciplinary management by a "Pregnancy Heart Team," she rapidly deteriorated to New York Heart Association Class IV. We performed an emergency caesarean section under general anaesthesia due to non-reassuring fetal status. She delivered a live male infant weighing 2600 grams. Postoperatively, we closely monitored her in the intensive care unit. We discharged her home on postoperative day 12, and both the mother and baby are doing well. Conclusion Favourable pregnancy outcomes are possible in late-presenting pregnant women with congenital heart disease through early intervention by the "Pregnancy Heart Team." Also, this case highlights the limitations of standard risk-stratification tools for cardiac events in pregnancy in sub-Saharan Africa. Improvements in antenatal screening and increased access to definitive cardiac surgical correction before conception are important for lowering maternal morbidity and mortality in low-resource settings.