Background: Shone complex is a rare congenital cardiac syndrome characterised by multiple left-sided obstructive lesions1. In pregnancy, these lesions substantially increase maternal and fetal risk, with haemodynamic changes often precipitating decompensation2.
Case: We report the case of a 34-year-old woman diagnosed with partial Shone complex during pregnancy. She had severe aortic coarctation, bicuspid aortic valve with stenosis, subaortic membrane, and abnormal mitral subvalvular apparatus. Despite early multidisciplinary planning, her pregnancy was complicated by progressive heart failure requiring two admissions for pulmonary oedema and escalating antihypertensive and diuretic therapy. Delivery was expedited at 35+6 weeks by elective caesarean section under regional anaesthesia. Postpartum, she required intensive care for persistent fluid overload, with echocardiography revealing new moderate diastolic dysfunction. Careful medical management and coordinated outpatient follow-up led to clinical stabilisation by two months postpartum.
Literature Review: A targeted review identified ten reported cases of Shone complex in pregnancy. Antenatal deterioration, pulmonary oedema, and preterm delivery were common, with caesarean section the most frequent delivery mode. Neonatal outcomes were generally favourable despite maternal morbidity.
Conclusion: Shone complex poses significant obstetric challenges, with a high risk of cardiac decompensation during pregnancy. This case underscores the importance of early diagnosis, individualised haemodynamic targets, and coordinated multidisciplinary management. Vigilance for comorbid conditions such as obstructive sleep apnoea, which may exacerbate heart failure, is essential. Achieving successful maternal and fetal outcomes is possible with careful planning and ongoing specialist care.