Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 08 29 1541 1541 Shweta Khatri Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Chappidi Reddy Kishan Reddy Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Shahbaz Hasnain Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2025 12 26 2026 02 07 Aortic coarctation represents a complex challenge during pregnancy due to altered cardiovascular physiology. We describe the successful perioperative management of a 24-year-old primigravida at 32 weeks of gestation with unrepaired coarctation of the aorta undergoing elective cesarean section. The patient presented with significant hypertension (upper limb 140-150/100 mmHg versus lower limb 90-100/70 mmHg) and dyspnea. Intraoperative management included dual invasive arterial line placement for continuous hemodynamic assessment, general anesthesia with careful titration of intravenous nitroglycerin (1 mL/hour), and thoughtful fluid administration resulting in a positive balance of 500 mL. Postoperative blood gas analysis demonstrated normal acid-base parameters. This case underscores the necessity for multidisciplinary coordination, invasive hemodynamic monitoring, and meticulous pharmacological intervention in high-risk cardiac pregnancies. https://aacc.tums.ac.ir/index.php/aacc/article/view/1541