Aortic complications in pregnancy: the less remembered chapter—a narrative review

Abstract

Pregnancy increases the risk of common vascular events and also the rarer events like aortic dissection (AD)/aortic rupture and this is even more pronounced in patients with predisposing aortopathies. AD was found to occur in 0.0004% of all pregnancies, and it is more pronounced in patients with underlying connective tissue disorders. The normal hemodynamic changes on a weak aorta will lead to AD and/or rupture, more so with increase in the period of gestation. Hence the haemodynamic and hormonal changes during pregnancy make pregnancy itself a risk factor for AD. It is advised that women with Marfan syndrome who are planning pregnancy should go through prophylactic aortic repair if the diameter of the ascending aorta exceeds 4 cm. Pre-pregnancy counselling is very important in these patients and must include complete history taking, including family history, physical examination and advanced aortic imaging. There is a general consensus among various authors advising against surgery during pregnancy in stable patients due to increased maternal and fetal morbidity but it is justified if the condition is refractory to medical management or in life threatening stage like acute AD. Though the incidence of aortopathy in pregnancy is rare, there is a high maternal and fetal mortality associated with this condition.

Type A aortic dissection during in pregnancy: Confront without aversion or delay

“…Few authors even advise termination of pregnancy and central aortic repair. 2 In agreement with Ayani et al, 1 the choice of imaging modality is one to be taken with care and consideration of the fetus's health. However, imaging-posed additional radiation exposure and teratogenicity of the contrast material, such as iodinated-or Gadolinium-based contrast media, must be avoided.…”

“…But if the patient is unstable, the risk has to be explained and the mother has to undergo central aortic repair. Few authors even advise termination of pregnancy and central aortic repair 2 …”