Intra- and post-partum acute aortic dissection (Stanford type B): Report of two cases

Aortic dissection during pregnancy and postpartum

BACKGROUND

Patients with aortic dissection during pregnancy and postpartum period exhibit a high mortality. At present, a complete overview of aortic dissection during pregnancy and postpartum period is lacking. ​Methods: This systematic review included 80 reports published from 2000 to 2020, comprising a total study population of 103 patients with aortic dissection. ​Results: We found that Stanford Type A aortic dissection was more common in prepartum cases, especially in the third trimester, while postpartum cases of aortic dissection were more common in Stanford Type B. The most common risk factor was connective tissue disease, with no other known risk factors. The mode of delivery had no significant effect on the type of postpartum aortic dissection. Reduced maternal and fetal mortality was observed when patients with Stanford Type A aortic dissection occurring after 28 gestational weeks underwent cesarean section followed by aortic replacement. Patients with Stanford Type B aortic dissection were treated mainly with medication and/or endovascular repair. ​Conclusion: Contemporary management of patients during pregnancy and within 12 weeks postpartum requires multidisciplinary cooperation and includes serial, noninvasive imaging, biomarker testing, and genetic risk profiling for aortopathy. Early diagnosis and accurate treatment are essential to reduce maternal and fetal mortality.

Pernicious pregnancy: Type B aortic dissection in pregnant women

BACKGROUND

Type B aortic dissection (TBAD) occurs seldomly, particularly in pregnancy, but has disastrous consequences for both mother and fetus. The focus of immediate surgical repair of type A aortic dissection due to higher mortality of patients is less clear in its counterpart, TBAD, in which management is controversial and debated. This article collates knowledge so far on this rare event during pregnancy.

METHODS

A comprehensive literature search was performed in PubMed, Scopus, Google Scholar, Embase, and Medline. Key search terms included "type B aortic dissection," "pregnancy," and corresponding synonyms. Non-English papers were excluded.

RESULTS

Risk factors for TBAD include aortic wall stress due to hypertension, previous cardiac surgery, structural abnormalities (bicuspid aortic valve, aortic coarctation), and connective tissue disorders. In pregnancy, pre-eclampsia is a cause of increased aortic wall stress. Management of this condition is often conservative, but this is dependent on a number of factors, including gestation, cardiovascular stability of the patient, and symptomology. In most cases, a cesarean section before intervention is carried out unless certain indications are present.

CONCLUSIONS

Due to a scarce number of cases across the decades, it is difficult to determine which management is optimal. The gold-standard management of TBAD has traditionally been the medical treatment for uncomplicated cases and open surgery for those needing urgent intervention, but with the advent of techniques, such as thoracic endovascular aortic repair, the management of these group of patients continues to develop.

Successful emergency management for aortic arch rupture in pregnancy at first trimesters: A case report

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The report about aortic arch rupture occurring during first-trimester pregnancy was very rare.

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It is the emergency condition with high mortality and the fetal loss is common.

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Emergency surgery for total aortic arch replacement in first-trimester pregnancy was safe for both mother and fetus.

Background

The aortic dissection and rupture in pregnancy are uncommon clinical situation, but they are emergency condition with high mortality for both mother and fetus. Here, we report a successful emergency management for pregnancy at first trimesters with aortic arch rupture in Vietnam.

Case presentation

A young pregnant woman (20-year-old) at 12-week’s gestation was transferred to our hospital due to chest pain (last 7 days on treatment) in severe medical condition: conscious responses to stimuli, oxygen 2 l/min directly through endotracheal tube, and hypertension (170/90 mmHg). The chest computed tomography scanner showed aortic arch aneurysm with the image of rupture. An urgent surgery for total aortic arch replacement with cardiopulmonary bypass (185 min) including heart arrest period (cross clamp time 80 min), and general hypothermia (25 °C) performed. She was discharged after 20 days with a normal pregnancy development.

Discussion

Aortic arch dissection occurring during 1st trimester was very rare. The mortality of aortic dissection without any treatments increased up to 70% at one week after presentation. The aortic arch replacement surgery was successful recuse her, and fortunately, the fetus was safe.

Conclusion

An emergency surgery for aortic arch replacement was safety for both mother and fetus at 12-week’s gestation.