Acute aortic dissection in postpartum

Abstract

DESCRIPTIONA Caucasian woman aged 35 years, with no relevant personal history or history of drug abuse and an uneventful pregnancy, presented in the emergency room (ER) at 34 weeks of gestation, with preterm premature rupture of membranes. On physical examination, she had elevated blood pressure and bilateral peripheral oedema. An extensive blood panel was performed, providing the diagnosis of pre-eclampsia. Four hours after admission, she had a vaginal delivery and, 36 hours later, discharged herself against medical advice. A few hours later, she returned to the ER, reporting of severe thoracic pain of sudden onset, sweating and nausea. Her vitals were within normal range, and peripheral pulses were present and symmetrical.Suspecting a pulmonary embolism, a thoracic CT was performed (figures 1-3), showing 'extensive dissection of the ascending aorta, extending from the aortic root to the origin of the celiac artery. No aneurism is observed'. The patient was transferred to our referral cardiothoracic surgery department, and submitted to an emergency replacement of the aortic root by a tubular prosthesis. The postoperative period was uneventful.Acute aortic dissection is a rare and lifethreatening condition, which can be presented in different forms and mimic other medical conditions.1 Despite its rareness, nearly half of the cases in young women occur during pregnancy, most commonly in the third trimester and peripartum. Since it requires a high level of clinical suspicion, and has an extremely high mortality rate if left untreated, this condition poses an enormous challenge, that obstetricians rarely encounter. Contributors TE admitted the patient initially. TE, AC and LC all followed the patient during the hospital stay. TE wrote the initial article, which was then revised by FF.Competing interests None declared. Patient consent Obtained.Provenance and peer review Not commissioned; externally peer reviewed.

Aortic dissection during pregnancy and postpartum

“…The systematic literature search yielded 465 potentially eligible studies. After exclusion, cross‐referencing, and reaching an agreement on three authors, 80 studies were included in this systematic literature review 5–84 (Figure 1). This resulted in a total study of 103 patients with aortic dissection during 6 months before delivery to 12 weeks postpartum.…”

Postpartum aortic dissection. A case report and review of literature

“…Data from cases have been summarized in Table 1 . Cases have been singularly reported in Table 2 [ [13] , [14] , [15] , [18] , [19] , [20] , [21] , [22] , [23] ]. Histograms have been built to resume data on timing of presentation, type of dissection, surgical options and maternal mortality [ Fig.…”