Antepartum acute Stanford type A aortic dissection: a case report and literature review

Abstract

Background Aortic dissection in pregnancy is a life-threatening event that is associated with high maternal and foetal mortality. Most cases occur during the third trimester of pregnancy, Herein, we describe a case of a pregnant woman with acute type A aortic dissection at 28 weeks of gestation. Case presentation A previously healthy, 24-year-old gravida 2 para 1 woman was brought to the emergency department during at the 28 weeks of gestation and diagnosed with acute type A aortic dissection. Cesarean section was performed with the cardiac surgical team on standby for cardiopulmonary bypass and the patient delivered a baby weighing 1000 g. After the operation, we performed the Beatall procedure and total arch replacement with FET using the deep hypothermic circulatory arrest technique. Both the mother and child survived and recovered well. A review of the literature on antepartum acute aortic dissection during pregnancy is also presented. Conclusion Women should have a comprehensive, systematic physical examination before getting pregnant. Women at high risks of aortic dissection must undergo multidisciplinary evaluation and be counseled before pregnancy, once they become pregnant, their consistent aortic root diameter should be consistently monitored, and their blood pressure strictly controlled.

Surgical management of a type A aortic dissection in a pregnant patient

“…In contrast, the European Society of Cardiology recommends delivery starting at 26 weeks gestation 17 . Additional literature has developed this strategy further by suggesting emergent cesarean section with sternotomy standby followed by surgical repair of the aorta within a few days 18 …”

“… 17 Additional literature has developed this strategy further by suggesting emergent cesarean section with sternotomy standby followed by surgical repair of the aorta within a few days. 18 …”

“…17 Additional literature has developed this strategy further by suggesting emergent cesarean section with sternotomy standby followed by surgical repair of the aorta within a few days. 18 Staged repair of type A ADs in pregnant patients has been reported in the past, patients with gestational ages ranging from 24 to 36 weeks and the interval between delivery and repair of the aortic defect occurring in the context of patient stability. 19,20 In our patient's case, the clinical team decided to have the patient undergo cesarean section first, in case of any hemodynamic instability that may have developed during the procedure.…”

Surgical Management of a Type A Aortic Dissection in a Pregnant Patient

“…4 Additional literature has developed this strategy further by suggesting emergent cesarean section with sternotomy standby followed by surgical repair of the aorta within a few days. 14 In our patient's case, the clinical team decided to have the patient undergo cesarean section first, in case of any hemodynamic instability that may have developed during the procedure.…”