Postpartum aortic dissection. A case report and review of literature

Silvestri, Valeria; Mazzesi, Giuseppe; Mele, Rita

doi:10.1016/j.ijscr.2019.02.018

Cited by 12 publications

(9 citation statements)

References 22 publications

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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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“…Pregnancy has more than 20 times increased risk of aortic dissection with the rate of aortic rupture during pregnancy of 1.39/100,000 woman-years compared to 0.06/100,000 in those who are not pregnant [ 1 , 2 ]. However, postpartum aortic dissection occurring between day 1 and day 42 after delivery remains a very rare event with only 27 cases reported in the literature from 1988 to 2012 [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy-associated aortopathy and sudden postpartum death

Byard

2023

Forensic Sci Med Pathol

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A 39-year-old woman who had undergone an uncomplicated elective cesarean section for a low-lying placenta collapsed and died the following day. At autopsy, there was dissection of an aneurysmally-dilated thoracic aorta with 400 mls of fluid and clotted blood in the pericardial sac. There were no features of Marfan syndrome or other connective tissue disorders. Histology revealed thinning of the aortic wall with fragmentation of elastic fibers and no inflammation. Vessels elsewhere were normal. This case demonstrates a rare complication of pregnancy that may not present until after delivery with unexpected collapse and sudden death. Predisposing factors include an increased cardiac output, reduction in systemic vascular resistance, an increase in left ventricular muscle mass, and alterations in serum progesterone and estrogen levels which may cause structural changes to the aortic wall. The possibility of syndromic and familial connective tissue disorders should also be considered.

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“…5 While there is no large series describing the dissection risk in women with chronic aortic dissection during pregnancy, women with aortopathies such as Marfan syndrome are at increased risk of dissection during pregnancy, particularly later in pregnancy and postpartum. 5,11–14 Therefore, close follow-up extending to the late postpartum period (up to six months) is recommended for all women with significant aortic disease. In this specific high-risk woman, our team decided upon in-hospital surveillance for the first week after delivery.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy in a woman with a chronic descending thoracic aortic dissection

et al. 2020

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Pregnancy increases aortic wall stress and, for a woman with a chronic dissection, this can lead to extension of the dissection, aortic rupture, and death. We report a pregnancy in a woman with a history of a chronic type B aortic dissection. As a child, she had repeat balloon dilation of aortic coarctation, and one of the procedures was complicated by an iatrogenic dissection at the dilation site. At the age of 27 years, she had a planned pregnancy.

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Postpartum aortic dissection. A case report and review of literature

Cited by 12 publications

References 22 publications

Aortic dissection during pregnancy and postpartum

Aortic dissection during pregnancy and postpartum

Pregnancy-associated aortopathy and sudden postpartum death

Pregnancy in a woman with a chronic descending thoracic aortic dissection

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