Aortic dissection during pregnancy: Treatment by emergency cesarean section immediately followed by operative repair of the aortic dissection

Katz, Nevin M.; Collea, Joseph V.; Moront, Michael G.; MacKenzie, Robert D.; Wallace, Robert B.

doi:10.1016/0002-9149(84)90290-x

Cited by 34 publications

(14 citation statements)

References 6 publications

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“…Acute aortic dissection may occur in pregnancy in association with severe hypertension due to pre-eclampsia, coarctation of the aorta, or connective tissue diseases such as Marfan's syndrome. 79 105 Although rare, aortic dissection occurring during pregnancy accounts for 50% of all dissections in women under 40 yr. 44 The mother typically presents with severe chest or interscapular pain associated with endorgan ischaemia (myocardial, renal, cerebrovascular, limb ischaemia) and=or acute heart failure secondary to acute aortic incompetence or haemopericardium and tamponade. Diagnosis is made by computed tomography or transoesophageal echocardiography.…”

Section: Aortic Dissectionmentioning

confidence: 99%

Recognition and management of maternal cardiac disease in pregnancy

Ray

Murphy

Shutt

2004

British Journal of Anaesthesia

124

111

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Heart disease is a leading cause of maternal death. The aim of this study is to review the most common causes of cardiac disease, highlight factors that should be recognized by the clinician, and address recent advances in the anaesthetic management of these patients. Incipient cardiac disease, including peripartum cardiomyopathy, myocardial infarction and aortic dissection, accounts for approximately one in six maternal deaths. The keys to successful diagnosis and management of incipient disease are: a high index of suspicion, particularly in women with known risk factors for cardiovascular disease; a low threshold for radiological investigations; early cardiology input; and invasive monitoring during labour and delivery. Echocardiography is a safe, non-invasive test, under-used in pregnancy. Management of pregnant women with pre-existing cardiac problems should be undertaken by multidisciplinary teams in tertiary centres. In women with pre-existing cardiac disease wishing to proceed to term, cardiac status must be optimized preoperatively and planned elective delivery is preferable. Vaginal delivery is preferable, and with careful incremental regional anaesthesia is safe in most women with cardiac disease. The presence of adequate systems for early detection, appropriate referral to specialist centres, and timely delivery with multidisciplinary support can minimize the serious consequences of poorly controlled heart disease in pregnancy.

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Section: Aortic Dissectionmentioning

confidence: 99%

Recognition and management of maternal cardiac disease in pregnancy

Ray

Murphy

Shutt

2004

British Journal of Anaesthesia

124

111

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“…During the 21 weeks of gestation she had endocarditis caused by staphylococci. Katz has reported a case of aortic dissection during pregnancy, where an emergency cesarean section was followed by operative repair of the aortic dissection (31).…”

Section: Maternal Deathmentioning

confidence: 99%

Maternal Heart Disease

Bitsch

Johansen

Wennevold

et al. 1989

Acta Obstet Gynecol Scand

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Among 87 pregnancies complicated by heart disease, delivered during the decade 1977-86, 70 (81%) had a congenital heart malformation, 7 (8%) an acquired heart disease and 10 (11%) arrhythmias or conduction disturbances. The incidence was 0.3%. The corresponding data from a report from Rigshospitalet during the 1950s were: 42%, 49%, and 9%, respectively, and an incidence of 0.9%. Ventricular septal defect (VSD) and atrial septal defect (ASD) were the most frequent malformations. The women were classified according to the NYHA before, during and after the pregnancy. All women except 4 re-entered their original functional class. In 51 cases, ECG showed completely normal sinus rhythm, while in 36, various degrees of arrhythmia or conduction disturbance were found as well as left or right ventricular hypertrophy and/or strains. Nine infants had congenital defects, 4 of which were a heart malformation (4.6%). One infant died. Gestational duration, weight and perinatal mortality did not differ significantly from that of the general population. Two women died, one of primary pulmonary hypertension and one with a rupture of the thoracic aorta. Rheumatic heart disease is no longer a significant factor in relation to pregnancy in Denmark, but congenital heart disease is still of great importance, because more survive and reach the age of fertility. Today most women can be brought safely through pregnancy, but obstetric, cardiologic and anesthesiologic expertise is still mandatory for a successful course and outcome of pregnancies complicated by heart disease.

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“…13,21 It has been estimated that $50% of all ascending aortic dissections in women under 40 years occur during pregnancy, mostly in the last 3 months of pregnancy. 22 In patients with aortic dissection, acute onset of severe sharp chest pain (in 72.7% of patients) is the most common presenting complaint. 7 The mortality rate for aortic dissection is $1% per hour during the first 24 hours after onset of symptoms and $75% at 2 weeks in untreated patients.…”

Section: Discussionmentioning

confidence: 99%

Acute Type A Aortic Dissection Complicating Pregnancy at 32 Weeks: Surgical Repair after Cesarean Section

Papatsonis

Heetkamp²,

Hombergh³

et al. 2008

Amer J Perinatol

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A 40-year-old, gravida 2, para 1 woman presented at a gestational age of 32 + 5 weeks' with sudden onset of a sharp chest and thoracic back pain. She was admitted 1 hour before the onset of pain because of some minor postcoital vaginal blood loss. Pregnancy was uneventful until 30 weeks of pregnancy when mild gestational diabetes was diagnosed. Computer tomography demonstrated a type A aortic dissection. A healthy male infant of 2105 g was delivered by emergency cesarean section followed by a Bentall procedure with composite graft replacement of the aorta, and aortic valve replacement was performed. Rapid multidisciplinary consultation, collaboration, and quick decision making led to a successful outcome for both the mother and her child.

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Aortic dissection during pregnancy: Treatment by emergency cesarean section immediately followed by operative repair of the aortic dissection

Cited by 34 publications

References 6 publications

Recognition and management of maternal cardiac disease in pregnancy

Recognition and management of maternal cardiac disease in pregnancy

Maternal Heart Disease

Acute Type A Aortic Dissection Complicating Pregnancy at 32 Weeks: Surgical Repair after Cesarean Section

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