Webster George J M, Kurtovic Jelica, Lowe Sandra A, Riordan Stephen M
Gastrointestinal and Liver Unit, The Prince of Wales Hospital, and Royal Hospital for Women, Sydney, Australia.
Obstet Gynecol. 2004 Nov;104(5 Pt 2):1151-4. doi: 10.1097/01.AOG.0000128108.68908.73.
Hepatic ischemia associated with coarctation of the aorta has not previously been reported in an adult; pregnancy increases the pressure gradient across a coarctation.
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.
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.
此前尚无成人主动脉缩窄相关肝缺血的报道；妊娠会增加主动脉缩窄处的压力梯度。
一名已知患有主动脉缩窄的年轻女性在孕期出现严重肝缺血。妊娠导致主动脉缩窄处平均压力梯度增加，从孕前的18毫米汞柱增至孕晚期的40毫米汞柱，在脱水情况下易引发严重肝灌注不足。
本病例证明了主动脉缩窄与肝缺血之间的关联，由妊娠和脱水共同诱发。它强调在评估孕期肝病患者时，不仅要考虑“传统”的妊娠相关疾病，如急性脂肪肝和溶血、肝酶升高、血小板减少综合征（在这些疾病中分娩可能作为临床急症是必要的），还要考虑那些妊娠时的循环和代谢需求可能引发肝损伤的情况。
