Repair of an acute type A aortic dissection combined with an emergency cesarean section in a pregnant woman

Shihata, Mohammad; Pretorius, Victor; MacArthur, Roderick

doi:10.1510/icvts.2008.182766

Cited by 25 publications

(12 citation statements)

References 6 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Yuan

2013

Clinical Cardiology

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Aortic dissection (AoD) during pregnancy is a rare but lethal condition and highlights the need for extensive elucidation. The aim of this study is to reveal the risk factors for AoD during pregnancy and to compare the 2 main risk factors, Marfan syndrome and pregnancy itself in the previously healthy woman. The pregnant patients developed AoD at 31.7 ± 7.6 weeks of gestation. It occurred much earlier in the Marfan patients than in the previously healthy women (30.7 ± 8.6 weeks of gestation vs 34.4 ± 4.4 weeks of gestation, P = 0.0263). In the Marfan patients, AoD developed in 3 (3.2%), 15 (15.8%), and 43 (46.3%) patients in the 3 trimesters, respectively, compared with 31 of the previously healthy women, and only in the third trimester. The neonates of the Marfan patients had better Apgar scores at 1 and 5 minutes, lower intubation rates, and fewer stays in the neonatal intensive care unit than those of the previously healthy women. Marfan syndrome and pregnancy itself in the previously healthy woman were the 2 main risk factors responsible for the occurrence of AoD during pregnancy. Marfan patients may develop AoD at an early age and an early stage of pregnancy, probably due to the preexisting weakened aortic wall. Better outcomes for the surviving neonates of Marfan patients compared with neonates of the previously healthy women might be the result of the poor condition of Marfan patients causing a higher death rate for those fetuses.

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Section: Resultsmentioning

confidence: 99%

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Yuan

2013

Clinical Cardiology

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“…We identified 50 articles that fit our inclusion criteria (41 solitary cases and 9 case series) . The 50 articles yielded a total of 72 patients who met the inclusion criteria (AAD during pregnancy or within 1 year postpartum).…”

Section: Methodsmentioning

confidence: 99%

Pregnancy-related acute aortic dissection in Marfan syndrome: A review of the literature

Smith

Gros

2017

Congenital Heart Disease

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A well-established association exists between acute aortic dissection and pregnancy, particularly in women with Marfan syndrome. However, there is debate regarding appropriate management guidelines. In particular, there are differing opinions regarding when prophylactic aortic root repair should be recommended as well as the efficacy of beta blockers in this clinical scenario. The current study evaluated 10 years of published literature (2005-2015) in the PubMed/Medline database. Fifty articles, describing 72 cases of women who presented with aortic dissection in the antepartum or postpartum period were identified. Comparisons on demographic variables and clinical outcomes between cases of women with Marfan syndrome (n = 36) and without Marfan syndrome (n = 36) were conducted. There were no significant differences in demographics (age, gravidity, parity) between the Marfan and non-Marfan cases. Marfan patients presented with antepartum dissections significantly earlier in pregnancy than those without Marfan syndrome (P = .002). However, there were no significant difference between the 2 groups in maternal mortality, fetal mortality, or obstetric outcomes (mode of delivery and gestational age at delivery). Eight cases described events in Marfan women with an aortic root diameter ≤40 mm. Six events occurred in Marfan women who were managed with beta blockers. Current guidelines rely on aortic root diameter for stratification of Marfan women into risk categories, but we identified several cases that would be missed by these guidelines. Specifically, the existing literature suggest that women with Marfan syndrome should take precautions throughout pregnancy, rather than the third trimester.

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“…Tỉ lệ tử vong tăng 1 -3% mỗi giờ sau nhập viện, chiếm 25% trong 24 giờ đầu, 70% trong 1 tuần và 80% trong 2 tuần [6]. Các yếu tố nguy cơ thường gặp của PBTĐMCN gồm tăng huyết áp (THA), các bệnh lý rối loạn collagen gồm có hội chứng Marfan, hội chứng Ehlers-Danlos, van động mạch chủ (ĐMC) 2 lá, tiền căn gia đình, chấn thương [2], [8]. Ngoài ra, nồng độ ngày càng cao của estrogen và progesterone trong giai đoạn gần cuối thai kỳ cũng là yếu tố làm thoái hóa thành ĐMC, tương tự như hoại tử lớp áo giữa dạng nang ở những BN bị bóc tách ĐMC và không mang thai.…”

Section: đặT Vấn đềunclassified

Hồi sức phình bóc tách động mạch chủ ngực Stanford A ở bệnh nhân nữ có thai: nhân 3 trường hợp lâm sàng

Trinh¹,

Tiến²

2020

VJCTS

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3 BN đều nhập viện cấp cứu vì đau ngực trái, tiền sử không ghi nhận bệnh động mạch chủ (ĐMC), không tăng huyết áp. 1 BN 20 tuổi thai 12 tuần bị bóc tách ĐMC ngực đoạn quai đường kính 60 mm, tụ máu quanh túi phình, khả năng vỡ. 1 BN 26 tuổi thai 31 tuần bị phình ĐMC ngực lên, có dấu bóc tách từ đoạn lên kéo dài dến chỗ chia động mạch thận 2 bên, đường kính xoang 62 mm, đoạn lên: 36 mm, hở van ĐMC trung bình. 1 BN 31 tuổi thai 33 tuần bị phình bóc tách gốc ĐMC và dãn nhẹ ĐMC ngực đoạn lên, hở van ĐMC nhẹ. 2 BN thai 31 tuần và 33 tuần được tiến hành phẫu thuật lấy thai trước và phẫu thuật điều trị PBTĐMCN sau, 2 bé sơ sinh được chăm sóc tốt tại bệnh viện phụ sản. Cả 3 thai phụ được điều trị phẫu thuật thay phình ĐMC ngực đoạn lên, 1 thai phụ thay van ĐMC sinh học. Phẫu thuật thành công không biến chứng. Riêng BN thai 12 tuần được hổ trợ progesterone sau mổ và tiếp tục thai kỳ. PBTĐMCN týp A hiếm gặp trong thai kỳ và gây tử vong rất cao cho cả mẹ và con. Hiện vẫn chưa có nhiều kinh nghiệm và khuyến cáo điều trị. Cần có sự phối hợp điều trị khẩn trương, kịp thời giữa các chuyên khoa sản, phẫu thuật tim và các bác sĩ gây mê, hồi sức.

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Repair of an acute type A aortic dissection combined with an emergency cesarean section in a pregnant woman

Abstract: This case report describes a 35-week pregnant woman presenting with an acute type A aortic dissection. She underwent a successful emergency surgical repair and a concomitant cesarean section with a favorable outcome for the mother and the child.

Cited by 25 publications

References 6 publications

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Pregnancy-related acute aortic dissection in Marfan syndrome: A review of the literature

Hồi sức phình bóc tách động mạch chủ ngực Stanford A ở bệnh nhân nữ có thai: nhân 3 trường hợp lâm sàng

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