Unstable angina during pregnancy in two patients with premature coronary atherosclerosis and aortic stenosis in association with familial hypercholesterolemia

Obstructive atherosclerotic coronary artery disease is uncommon in women du ring childbearing age, and the occurrence of myocardial ischemia during pre gnancy has therefore been anecdotal. Two young patients with premature coro nary arterary disease in association with familial hypercholestrolemia had unstable angina in the second trimester of pregnancy. Workup revealed coron ary artery disease and aortic stenosis. One patient opted for abortion at t he twentieth week of gestation, and the other decided to continue pregnancy and was delivered by cesarean at 28 weeks' gestation. Coronary artery bypa ss grafting was performed after pregnancy in both patients. In addition, on e of the patients underwent aortic valve replacement, and other had replace ment of the narrowed ascending aorta with uneventful recovery. Our report d escribes an uncommon presentation of unstable angina during pregnancy in 2 young women with premature coronary artery disease and aortic valvular and supravalvular stenosis as a result of familial hypercholesterolemia. The ma nagement of these conditions during pregnancy is influenced by the effects of available therapeutic modalities on both maternal and fetal outcome.