Managing aortic aneurysms and dissections during pregnancy

Abstract

Cardiovascular diseases during pregnancy account for significant morbidity and mortality, with aortic aneurysms, complicated by aortic dissection or rupture, being high on the list of underlying causes in this category. Correct knowledge of the diagnosis, risks and treatment is mandatory to improve the outcome and save lives. In this article, the authors aim to provide an overview of the underlying causes and risk factors for aortic aneurysms and dissections during pregnancy, while presenting the ways of preventing and treating these conditions. Although an important focus lies on the proximal part of the aorta due to it bearing the greatest risk for complications and being more frequently implicated in aortic disease in younger subjects, many aspects on the etiology and underlying diseases also apply to the other parts of the vessel.

Aortic aneurysm and dissection in pregnancy: A case report

“…In patients with a known aneurysm, vaginal delivery is reserved for aortic root diameters less than 4 cm [ 8 ]. Cesarean delivery is recommended for aortic root diameters over 4 cm, significant progression of the aneurysm, or previous dissection or repair [ 1 ].…”

Acute Type A Aortic Dissection during Pregnancy: Trials and Tribulations

“…It should be noted that many aortopathies are often only diagnosed following maternal death or cardiovascular event; in the Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) study, 42% were aware of their MFS prior to their first pregnancy 5,21 . The aorta is counted as dilated once the diameter exceeds the upper limit of normal; 2 standard deviations greater than the mean predicted diameter matched for age and size 22 .…”

“…For MFS patients with an aortic root >40mm but <45mm, it is unclear how to accurately assess risk of AAD in pregnancy; a suggestion of risk estimates at 10% once >40mm 22 . Immer et al recommended prepregnancy surgery with elective aortic root replacement in their study for those with aortic root dilatation >40mm 28 .…”

“…to conclude that the decision of pregnancy in vEDS should be based on expert discussion and planning with the patient involved, and not contraindicated based on genetic diagnosis. The use of celiprolol, a B1adrenoceptor antagonist, has also been noted to improve cardiovascular adverse events and could be utilised during pregnancy, subject to fetal monitoring 22 .…”

Management of aortic aneurysm presenting during pregnancy: A case report

“…Aortic aneurysm is an uncommon pathology in women of childbearing age, often associated with catastrophic outcomes. 1,2 Hemodynamic and hormonal changes in pregnancy, especially those occurring during labor increases the stress to aorta. As a result, the risk of dissection and rupture increases with gestational age.…”