Aortic dissection during pregnancy.

Abstract

SUMMARY Aortic dissection occurred in a nineteen year old woman during the thirty seventh week of pregnancy. Immediate elective delivery of a normal baby by caesarean section was followed by aortic root replacement 48 hours later. It was decided not to proceed immediately to operation on the aortic root because it was believed that the anticoagulation necessary for cardiopulmonary bypass might provoke dangerous haemorrhage from the raw placental site. Case reportA nineteen year old woma-n booked in for her first pregnancy at the local hospital. She remained well and fetal growth was normal until the thirty seventh week when she complained to her general practitioner of dizziness and a discomfort in her neck and chest radiating through to her back. Clinical examination at that time was normal. Two days later, however, her husband noted vibration in her chest and the family doctor confirmed the presence of new cardiac murmurs.She was admitted to the local district hospital, and one week later was referred to the regional centre. On admission she had mild chest discomfort and tiredness. Clinical examination showed no signs of heart failure. She was normotensive with a blood pressure in both arms of 105/55 mmHg. A systolic thrill was present to the right of the upper part of the stemum, and on auscultation an ejection systolic and early diastolic murmur were heard.A chest radiograph showed an enlarged cardiac shadow but the upper mediastinum was normal (Fig. 1). The electrocardiogram was normal. Cross sectional ultrasound examination showed that the aortic root was 7 cm in diameter; in the short axis view the aortic root was shown to consist of a normal sized main lumen with a large false lumen on the right side (Fig. 2).

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

“…The literature retrieval yielded 96 reports, comprising 85 case reports and 11 case series or original articles, with 122 patients . Mean patient age (n = 120) was 31.6 ± 4.7 years (range, 19–43 years; median, 31.5 years) on admission.…”

Aortic dissection causing embolic stroke

“…[3] Chronic systemic hypertension is the most common risk factor, followed by connective tissue diseases such as Marfans syndrome and Ehlers Danlos syndrome. [4] Our patient had no clinical signs of connective tissue disease. One unique finding in this patient was the presence of normal peripheral pulses.…”

Aortic dissection accompanied by preeclampsia in a postpartum young woman

“…This is because the use of anticoagulant is equired for the surgery; and if anticoagulant is used right after the delivery, uterine hemorrhage should be considered. Pumphyrey performed a surgery for the aortic dissection 48 hours after a cesarean section on the patient of 37 weeks gestation with DeBakey type II [ 12 ]. However, Snir et al [ 13 ] reported that surgery for aortic dissection was performed immediately after the cesarean section.…”