Acute Type A Aortic Dissection and Successful Surgical Repair in a Woman at 21 Weeks Gestational Pregnancy With Maternal and Fetal Survival: A Case Report

Barrus, Adam B.; Afshar, Sam; Sani, S H Danesh; LaBounty, Troy G.; Padilla, César; Farber, Michaela K.; Rudikoff, Andrew G.; Conte, Antonio Hernandez

doi:10.1053/j.jvca.2017.09.011

Cited by 9 publications

(9 citation statements)

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“…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.…”

Section: Resultsmentioning

confidence: 99%

Aortic dissection during pregnancy and postpartum

Meng

Han

Wang

2021

Journal of Cardiac Surgery

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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.

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Section: Resultsmentioning

confidence: 99%

Aortic dissection during pregnancy and postpartum

Meng

Han

Wang

2021

Journal of Cardiac Surgery

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“…The current guidelines suggested that low doses of radiation during CTA was acceptable in the diagnosis of aortic diseases in pregnancy[12]. Barrus et al[13] also suggested that CTA should be the primary diagnostic tool, and TTE should be a supplementary diagnostic method.…”

Section: Discussionmentioning

confidence: 99%

“…Immer-Bansi et al[14] reported a patient in which misinterpretation of the intraoperative cardiotocography led to an emergency caesarean section. Moreover, Barrus et al[13] reported a patient with aortic dissection who underwent repair surgery without effective monitoring for the fetus. Although the above studies consider medically futile of the intraoperative fetal monitoring, we believe that it can provide useful feedback for managing CPB and make a comprehensive assessment of the fetus during and after surgery.…”

Section: Discussionmentioning

confidence: 99%

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Successful repair of acute type A aortic dissection during pregnancy at 16^th gestational week with maternal and fetal survival: A case report and review of the literature

Chen

Zhong

et al. 2019

WJCC

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BACKGROUNDAortic dissection during pregnancy is a rare but life-threatening event for mothers and fetuses. It often occurs in the third trimester of pregnancy and the postpartum period. Most patients have connective tissue diseases such as Marfan syndrome. Thus, the successful repair of a sporadic aortic dissection with maternal and fetal survival in the early second trimester is extremely rare.CASE SUMMARYA 28-year-old woman without Marfan syndrome presented with chest pain at the 16th gestational week. Aortic computed tomographic angiography confirmed an acute type A aortic dissection (TAAD) with aortic arch and descending aorta involvement. Preoperative fetal ultrasound confirmed that the fetus was stable in the uterus. The patient underwent total arch replacement with a frozen elephant trunk using moderate hypothermic circulatory arrest with the fetus in situ. The patient recovered uneventfully and continued to be pregnant after discharge. At the 38th gestational week, she delivered a healthy female infant by cesarean section. After 2.5 years of follow-up, the patient is uneventful and the child’s development is normal.CONCLUSIONA fetus in the second trimester may have a high possibility of survival and healthy growth after aortic arch surgery.

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“…Majority of them describe the dissection in the third trimester, which is in fact the most vulnerable period [16,17,18]. Only two case reports describe the surgical repair of Stanford type A AD before the third trimester with maternal and fetal survival in both of them [19,20]. Liu et al [21] reported five cases of Bentall operation in Stanford type A AD during pregnancy, only one of which happened before the third trimester (22 GW), with both mother and fetus diseased.…”

Section: Discussionmentioning

confidence: 99%

Pregnant woman survives aortic dissection, dies later of coronary embolism - a unique case of a non-compliant patient

et al. 2019

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Introduction The incidence of aortic dissection ranges 3-5 cases per 100,000 person-years. In women under the age of 40 who acquire aortic dissection, almost half of the cases happen during pregnancy. Case outline We report a case of a 22-year-old pregnant woman in the 16th gestational week with a history of arterial hypertension and known aortic dilatation, who was admitted with aortic dissection. She underwent the Bentall procedure, in which her aortic valve, ascending aorta, and proximal part of the aortic arch were replaced using valved composite graft. On the next day, the evacuation abortion was made, since the fetus didn't survive the operation. Six years later, the patient stopped taking anticoagulation therapy and was admitted for prosthetic valve thrombosis, which was successfully treated with intravenous heparin. One year later, the patient died of a myocardial infarction due to coronary thromboembolism, confirmed on autopsy. Conclusion Preconceptional counseling in women with a known aortic disease is of the utmost importance. Aortic dissection in pregnant women is an acute life-threatening condition for both mother and fetus that should be managed by a multidisciplinary team. After a mechanical heart valve implantation, lifetime oral anticoagulants are mandatory.

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Acute Type A Aortic Dissection and Successful Surgical Repair in a Woman at 21 Weeks Gestational Pregnancy With Maternal and Fetal Survival: A Case Report

Cited by 9 publications

References 30 publications

Aortic dissection during pregnancy and postpartum

Aortic dissection during pregnancy and postpartum

Successful repair of acute type A aortic dissection during pregnancy at 16^th gestational week with maternal and fetal survival: A case report and review of the literature

Pregnant woman survives aortic dissection, dies later of coronary embolism - a unique case of a non-compliant patient

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Acute Type A Aortic Dissection and Successful Surgical Repair in a Woman at 21 Weeks Gestational Pregnancy With Maternal and Fetal Survival: A Case Report

Cited by 9 publications

References 30 publications

Aortic dissection during pregnancy and postpartum

Aortic dissection during pregnancy and postpartum

Successful repair of acute type A aortic dissection during pregnancy at 16th gestational week with maternal and fetal survival: A case report and review of the literature

Pregnant woman survives aortic dissection, dies later of coronary embolism - a unique case of a non-compliant patient

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Successful repair of acute type A aortic dissection during pregnancy at 16^th gestational week with maternal and fetal survival: A case report and review of the literature