Successful Repair of Type a Aortic Dissection in a Term Pregnancy: A Case Report

Document Type: Case Report

Authors

1 Cardiac Surgeon, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,Iran

2 Anaesthesiologist, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,Iran

3 Gynecologist, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,Iran

Abstract

Stanford type A acute aortic dissection (AAD) is a very rare complication, with potentially lethal consequences in pregnancy. In fact, pregnancy has been regularly associated with the possibility of aortic. dissection in almost half of young women. Herein, we present the case of a 38-year-old woman in her 37th week of pregnancy. The patient’s medical history was indicative of G4L2Ab1(4 gestaitions,2 lives, 1 abortion). She developed persistent chronic pain in the neck, chest, and back, without nausea or vomiting while waking in the morning. The computed tomography angiogram was indicative of AAD. The medical decision was to perform a combination of cesarean section under general anesthesia and median sternotomy for the open aortic valve. The term newborn showed an Apgar score of 9-10. The coronary arteries were preserved and the valve was repaired at commissural positions. Dacron supracoronary tube graft was attached to the aortic anastomotic site and subsequently to the aortic arch. The patient was discharged on day three after surgery with a good general condition. Moreover, the results indicated that she and one of her brothers suffered from Marfan syndrome.

Keywords


  1. Manalo-Estrella P, Barker AE.Histopathologic findings in human aortic media associated with pregnancy. Archives of Pathology 1967;83: 336-341.
  2. Konishi Y, Tatsuta N,Kumuda K, Minami K. Dissecting aneurism during pregnancy and the puerperium.Japanese Circulation Journal 1980;44:726-733.
  3. M. Shihata, V. Pretorius, R.Mac Arthur, “Repair of an type A aortic dissection combined with an emergency cesarean section in a pregnant woman,” Interactive Cardiovascular and Thoracic Surgery, 2008 vol. 7, no. 5, pp. 938–940,
  4. Pitt MP, Bonser RS. The natural history of thoracic aortic aneurysm disease: an overview. J Card Surg 1997; 12: 270–8
  5. Cunningham GF, Leveno JK, Bloon LS, Sponf YC,et al.Williams obstetrics.24th edition. MC Graw Hill Companies Inc. 2014 Volume 2;49:992
  6. Thalmann M1, Sodeck GH, Domanovits H, Grassberger M, Loewe C, Grimm M.et al.Acute type A aortic dissection and pregnancy: a population-based study Eur J Cardiothorac Surg. 2011 ;39:e159-63
  7. Immer FF, Bansi AG, Immer-Bansi AS, McDougall J, Zehr KJ, Schaff HV, et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Ann Thorac Surg
  8. Nienaber CA, Fattori R, Mehta RH, Richartz BM, Evangelista A, Petzsch M, et al. Gender-related differences in acute aortic dissection. Circulation. 2004;109:30143021.
  9. Kim TE, Smith DD. Thoracic aortic dissection in an 18-year-old woman with no risk factors. J Emerg Med. 2010;38:e41–e44.
  10. M. P. I. Pitt and R. S. Bonser, The natural history of thoracic aortic aneurysm disease: an overview,” J Cardiothorac Surg, 1997  vol. 12, no. 2, pp. 270–278,.
  11. Chen K1, Varon J, Wenker OC, Judge DK, Fromm RE Jr, Sternbach GL. Acute thoracic aortic dissection: the basics. J Emerg Med. 1997;15:859–867.
  12. Cheitlin MD, Armstrong WF, Aurigemma GP et al. ACC/AHA/ ASE 2003 guideline update for the clinical application of echocardiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). American College of Cardiology website. Available at: www. acc.org/clinical/guidelines/echo/index.pdf
  13. ZeegbregtsCJ, Schepens MA, Hameeteman TM, Morshuis WJ, and de la Rivi`ere AB, “Acute aortic dissection complicating pregnancy,” Ann Thorac Surg, 1997  vol. 64, pp. 1345–1348,.
  14. Kinney-Ham L, H. Bryant Nguyen, Steele R, L. Walters E. Acute Aortic Dissection in Third Trimester Pregnancy without Risk Factors. West J Emerg Med. 2011;12:571–574.
  15. Kohli E, Jwayyed SH, Giorgio G, Bhalla MC. Acute Type A Aortic Dissection in a 36-Week Pregnant Patient. Hindawi Publishing Corporation Case Reports in Emergency Medicine Volume 2013, Article ID 390670, 3 pages http://dx.doi.org/10.1155/2013/390670.