Acute Type A Aortic Dissection in a 36-Week Pregnant Patient

Abstract

Aortic dissection is a relatively rare yet often fatal condition. Early recognition and treatment are crucial for survival. While the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, and a family history of aortic dissection are also at an increased risk for developing this condition. A review of the literature revealed a paucity of published cases describing the successful, emergent repair of acute type A aortic dissections in third- trimester gravid patients. We present the case of the successful diagnosis and surgical repair of a 41-year-old female who presented to the emergency department with an acute type A aortic dissection at 36 weeks of gestation.

Pregnant woman survives aortic dissection, dies later of coronary embolism - a unique case of a non-compliant patient

“…There is a limited number of similar cases in the literature. Majority of them describe the dissection in the third trimester, which is in fact the most vulnerable period [16,17,18]. Only two case reports describe the surgical repair of Stanford type A AD before the third trimester with maternal and fetal survival in both of them [19,20].…”

Aortic Dissection: Simulation Tools for Disease Management and Understanding

“…Pregnancy: Studies have shown that physiological changes during pregnancy could lead to AD (Burchell, 1955;Nguyen et al, 2002). A number of case reports describe specific conditions for this relatively rare occurrence (Kinney-Ham et al, 2011;Kohli et al, 2013;Aziz et al, 2011).…”

A 37-Year-Old Patient Presenting at 39 Weeks of Pregnancy with Thoracic Aortic Dissection Due to Previously Undiagnosed FBN1-Related Marfan Syndrome

“…Risks factors associated with aortic dissection include hypertension, collagen disorders such as Marfan syndrome, Ehlers-Danlos syndrome, bicuspid aortic valve, and Turner syndrome; inflammatory diseases leading to vasculitis such as giant cell arteritis, Takayasu arteritis, rheumatoid arthritis; and a family history of aortic dissection and preexisting aortic aneurism [ 3 – 6 ]. Pregnancy per se is a risk factor of aortic dissection, likely secondary to the physiologic hemodynamic changes that lead to increased circulatory volume and elevated systemic blood pressure, and to the hormonal alterations that cause structural changes in the aorta [ 7 – 9 ]. Pregnant women with underlying aortopathies such as Marfan syndrome are more susceptible to pregnancy-related aortic dissection [ 7 ].…”