Dissecting Aortic Aneurysm during Pregnancy

Mandel, William J.; Evans, Evan; Walford, Roy L.

doi:10.1056/nejm195412232512607

Cited by 94 publications

(26 citation statements)

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“…Other disease states, including arteriosclerosis, lupus erythematosus, dermatomyositis, severe liver disease, and nephrotic syndrome, showed mild but inconstant changes in inhibitor levels (Walford and Schneider, 1959). The regular elevation of elastase inhibitor in late pregnancy is of interest in view of the increased incidence of dissecting aortic aneurysm, which is primarily an elastic tissue disease, in pregnancy (Mandel, Evans, and Walford, 1954). Elastase inhibitor levels might thus reflect changes in the status of elastin or elastase in the body.…”

mentioning

confidence: 99%

Serum Elastase Inhibitor Levels in the Ehlers-Danlos Syndrome

Pk¹,

Rl²

1963

Annals of the Rheumatic Diseases

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mentioning

confidence: 99%

Serum Elastase Inhibitor Levels in the Ehlers-Danlos Syndrome

Pk¹,

Rl²

1963

Annals of the Rheumatic Diseases

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“…1 There is much debate about whether pregnancy may contribute to the pathogenesis of vascular dissections. [2][3][4][5][6] Cardiovascular changes in pregnancy and decreasing peripheral vascular resistance may increase the risk of arterial aneurysm and dissection during pregnancy. 7 Also, the high levels of female hormones during pregnancy are believed to affect the structure and integrity of major arteries.…”

Section: Introductionmentioning

confidence: 99%

Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry

Chapelle¹,

Schutte

Schuitemaker

et al. 2011

BJOG

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Objective To determine the incidence of maternal deaths attributable to vascular dissection and rupture in the Netherlands, and to assess clinical features, risk factors and the frequency of substandard care in the cases identified.Design Confidential enquiry into the causes of maternal deaths.Setting Nationwide in the Netherlands. Results A total of 23 maternal deaths attributable to vascular dissection and rupture were reported. In most cases the location was aortic (n = 13), followed by coronary (n = 4) and splenic (n = 3) arteries. Clinical features were various, but most women presented with sudden unexplainable pain. Risk factors were present in 14 cases (61%), with hypertension being most frequently reported in ten cases (43%). Substandard care was determined to have been received in 13 cases (56%), inadequate assessment of complaints and a delay in diagnosis being the most frequent problems identified.Conclusions Vascular dissection and rupture in pregnancy, although rare, carry a high risk of maternal and fetal morbidity and mortality. Because of the rarity of this condition and its variety in presentation, diagnosis is easily missed. A high index of suspicion when a woman presents with suggestive complaints, leading to an early diagnosis, may improve the prognosis for the woman and her child.Keywords Aneurysm, aortic dissection, carotid artery dissection, coronary dissection, hepatic artery dissection, iliac artery dissection, maternal mortality, pregnancy-related, splenic artery dissection, substandard care, vascular dissection, vascular rupture.Please cite this paper as: la Chapelle C, Schutte J, Schuitemaker N, Steegers E, van Roosmalen J on behalf of the Dutch Maternal Mortality Commitee. Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry. BJOG 2012;119:86-93.

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“…Doerr and Koch (1958) normal. A possible relationship between oestrogen and progesterone balance has also been suggested by Mandel, Evans and Walford (1954) and this is of interest in view of the endocrine disturbance in Turner's syndrome. In view of the possibility of surgical repair, dissecting aortic aneurysm should be considered in all patients with Turner's syndrome presenting with chest pain, irrespective of the presence or absence of coarctation.…”

Section: Discussionmentioning

confidence: 89%

Turner’s syndrome associated with bicuspid aortic stenosis and dissecting aortic aneurysm

Slater

Grundman

Mitchell

1982

Postgraduate Medical Journal

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Summary A case of Turner’s syndrome is described associated with bicuspid aortic stenosis and fatal rupture of a thoracic dissecting aortic aneurysm. Histology of the aneurysm showed severe cystic medial necrosis. This association has not been previously described in the absence of coarctation. In view of the possibility of surgical repair, dissecting aortic aneurysm should be considered in all patients with Turner’s syndrome presenting with chest pain, irrespective of the presence or absence of coarctation.

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Dissecting Aortic Aneurysm during Pregnancy

Cited by 94 publications

References 11 publications

Serum Elastase Inhibitor Levels in the Ehlers-Danlos Syndrome

Serum Elastase Inhibitor Levels in the Ehlers-Danlos Syndrome

Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry

Turner’s syndrome associated with bicuspid aortic stenosis and dissecting aortic aneurysm

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