Acute Type A Aortic Dissection in Pregnancy—Diagnostic and Therapeutic Challenges in a Multidisciplinary Setting

Patel, Prakash A.; Fernando, Rohesh J.; MacKay, Emily J.; Yoon, Jeongae; Gutsche, Jacob T.; Patel, Saumil; Shah, Ronak; Dashiell, Jillian M; Weiss, Stuart J.; Goeddel, Lee A.; Evans, Adam S.; Feinman, Jared W.; Augoustides, John

doi:10.1053/j.jvca.2018.01.035

Cited by 13 publications

(15 citation statements)

References 49 publications

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“…The common risks of aortic disease were gene disorders and hypertension, thus the pregnancy with high blood pressure or Marfan syndrome, Ehlers-Danlos syndrome … should be confirm the differential diagnosis with aortic dissension or rupture when they had acute chest pain [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]].…”

Section: Discussionmentioning

confidence: 99%

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

Tran

2019

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

“…Hemodynamic and hormonal changes in pregnancy increase the risks the cardiovascular events, and the common risks of aortic disease include hypertension, gene mutation related to extracellular matrix disorders such as Marfan syndrome, Ehlers Danlos syndrome, bicuspid aortic valve and trauma [[1], [2], [3], [4], [5], [6], [7], [8]].…”

Section: Introductionmentioning

confidence: 99%

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

Tran

2019

International Journal of Surgery Case Reports

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“…Pregnancy was associated with a 4-fold risk of AD compared with the control period within 1 year following delivery ( 3 ). The ages ranged from 22 to 43 years with a mean age of 31.0 years, and the gestational age ranged from 8–38 weeks with a mean gestation of 28.7 weeks [summarized data from 30 cases presented in Table II ( 2 , 4 , 6 , 8 , 11 , 15 – 21 )]. ADs in pregnancy were predominantly Type A dissection (~80%) ( 1 , 5 , 7 , 8 ) as the gravid uterus induces significant compression of the aorta and iliac arteries, particularly in the supine position.…”

Section: Discussionmentioning

confidence: 99%

Type A aortic dissection in pregnant patients with fibrillin‑1 gene mutations: Two case reports and a literature review

et al. 2018

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In acute aortic dissection (AD) in pregnancy, increased cardiovascular stress due to pregnancy is an important factor leading to an emergent aortic event. It is rare but often results in a devastating event for both the pregnant patient and the foetus. Two cases of acute AD (Stanford type A) in pregnant females are presented in the present study. The patients were diagnosed via echocardiography, and the diagnosis was confirmed with computed tomography angiography prior to aortic surgery. Up to 50% of ADs in pregnancy occur in patients with fibrillin-1 (FBN1) gene mutations. The FBN1 gene was sequenced in both patients, and notable, novel pathogenic mutations of FBN1 were identified in both patients. A literature review was also performed on available diagnostic imaging and other measurements regarding AD during pregnancy. The authors suggest that the relevant content may have important clinical implications in raising disease awareness, arranging test rationally and choosing an intervention method.

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“…Analysis of case studies has shown a link between hypothermia during CPB and increased foetal mortality 4,8 . One hypothesis for this increase in mortality is due to induced foetal bradycardia.…”

Section: Aortic Repair With Fetus In Uteromentioning

confidence: 99%

“…Similarly, Kamel et al performed a cohort-crossover analysis on emergency department visits across several states of the US, identifying 36 cases of AAD during pregnancy in 6 566 826 pregnancies; an absolute risk of 5.5 per million cases 3 . Regardless of the rarity of the incidence of the disease, the mortality is high enough (21 -53%) for it to be notable 4 . Maternal mortality rates increase by 1-3% per hour and exceed 80% during the first month if left untreated 5 .…”

Section: Introductionmentioning

confidence: 99%

Acute Type A Aortic Dissection during Pregnancy: Trials and Tribulations

Rimmer

Heyward-Chaplin

South

et al. 2020

Preprint

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Type A acute aortic dissection (TAAD) during pregnancy is a life-threatening event for both the mother and unborn baby. Pregnancy has been recognised as an independent risk factor for TAAD, postulated to be due to physiological changes that cause hyperdynamic circulation. Presentation can be atypical in many cases and further concern from clinicians of fetal radiation exposure can result in missed or delayed diagnoses. Investigation via quickest form of imaging, whether CT, MRI or transoesophageal echocardiography, should be carried out promptly due to the high risk of mortality. Surgical management of TAAD in pregnancy revolves primarily around the decision to deliver the foetus concomitantly or to perform aortic repair with the foetus in utero. This review will summarise the difficulties faced when managing TAAD in pregnancy, and important questions for future research.

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Acute Type A Aortic Dissection in Pregnancy—Diagnostic and Therapeutic Challenges in a Multidisciplinary Setting

Cited by 13 publications

References 49 publications

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

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

Type A aortic dissection in pregnant patients with fibrillin‑1 gene mutations: Two case reports and a literature review

Acute Type A Aortic Dissection during Pregnancy: Trials and Tribulations

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