Acute Type A Aortic Dissection during Late Pregnancy Period in a Patient with Marfan's Syndrome

Abstract

A 34-year-old female with a gestational age of 38 weeks developed acute type A aortic dissection. Appearance of this patient was typical for Marfan s syndrome, and echocardiography revealed annuloaortic ectasia with mild aortic regurgitation, but pericardial effusion was absent. As her hemodynamic condition was stable, an emergency Caesarean section was carried out first. After careful observation in the ICU for half a day, she successfully underwent aortic valve reimplantation and replacement of the ascending aorta under deep hypothermic circulatory arrest. Intraoperative heparin use minimally impacted uterine bleeding. Both the mother and the neonate were discharged home 16 days later. We believe a two-stage strategy should be adopted whenever possible.

A patient with Marfan’s syndrome who developed an acute aortic dissection at 28 weeks of pregnancy treated with aortic root replacement

“…The fetal demise rate under an artificial heart–lung machine is 20% [ 12 ]; however, hypothermic circulatory arrest has been reported to cause increased fetal demise and severe brain complications [ 12 , 13 ]. In addition, the neonatal survival rate in Japan is > 80% after 24 weeks [ 14 ]. In the case of this patient, the hemodynamics was steady and there was time to perform cesarean section first; thus, the fetus was delivered by cesarean section with maternal lifesaving as the priority.…”