Outcomes in pregnant women with acute aortic dissections: a review of the literature from 2003 to 2013

Rajagopalan, Suman; Nwazota, Nenna; Chandrasekhar, Shobana

doi:10.1016/j.ijoa.2014.05.001

Cited by 77 publications

(90 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The fetal mortality rate was 10% for type A and 35% for type B aortic dissections. 4) Our patient felt sudden upper abdominal and back pain during labor. However, aortic dissection was not diagnosed until her consultation 7 days postdelivery.…”

Section: Discussionmentioning

confidence: 71%

Peripartum Type A Aortic Dissection Repair Using Frozen Elephant Trunk Technique

Iida

Ito²,

Inaba³

et al. 2016

Annals of Vascular Diseases

View full text Add to dashboard Cite

A 43-year-old woman with abdominal and back pain during childbirth consulted us 1 day postdelivery. Contrastenhanced computed tomography (CT) revealed partially thrombosed type A aortic dissection with intimal tear in the proximal descending thoracic aorta. Conservative antihypertensive treatment was started. However, her abdominal pain progressively deteriorated. Repeat CT revealed narrowing of the descending aorta true lumen and progressive bowel malperfusion. Total arch replacement was urgently performed using the frozen elephant trunk technique. Postoperative CT showed true lumen widening and symptom disappearance. Follow-up CT demonstrated excellent aortic remodeling. Keywords: peripartum aortic dissection, pregnancy, aortic remodeling Case ReportA 43-year-old woman under hypertension medication consulted us for sudden postpartum upper abdominal and back pain. She delivered a baby girl 7 days ago and since then felt refractory continuous upper abdominal and back pain. On admission, her height was 157 cm and her weight was 68 kg, without any Marfan syndrome or Loeys-Dietz syndrome features. Her blood pressure was 182/92 mmHg, with no difference in both arms. Chest X-ray showed mediastinal enlargement.Contrast-enhanced computed tomography (CT) showed type A aortic dissection. The primary entry tear was in the proximal site of the distal arch (Fig. 1A). The descending aorta true lumen was compressed by the false lumen owing to the large entry in the distal arch (Fig. 1B). Conservative antihypertensive treatment was started because of the thin and thrombosed ascending aorta false lumen. The patient's blood pressure decreased to 122/56 mmHg. However, her abdominal pain progressively deteriorated. Repeat CT revealed narrowing of the descending aorta true lumen (Fig. 2A); visceral malperfusion worsening was anticipated (Fig. 2B).Considering the progressive risk of visceral malperfusion, the patient underwent urgent operation. To resect the primary entry tear and enlarge the true lumen distally as extensively as possible, we performed total arch replacement using the FET technique. Following median sternotomy, cardiopulmonary bypass (CPB) was established. Under circulatory arrest (CA) with selective cerebral perfusion (SCP) at a rectal temperature of 25°C, the ascending aorta was opened. There was an intimal tear in the proximal descending aorta. The proximal descending aorta was constituted to obliterate the false lumen. For the FET technique, a 26-mm-diameter stent graft (J Graft open stent graft, Junken Medical Co., Ltd., Chiba, Japan) was introduced and deployed antegradely into the descending aorta true lumen. The integrated Dacron graft was pulled out and sutured with the orifice of the previously constituted descending aorta. Three arch vessels were reconstructed using a tetrafurcated 24-mm-diameter woven Dacron graft (J Graft Shield Neo, Junken Medical Co.,

show abstract

Section: Discussionmentioning

confidence: 71%

Peripartum Type A Aortic Dissection Repair Using Frozen Elephant Trunk Technique

Iida

Ito²,

Inaba³

et al. 2016

Annals of Vascular Diseases

View full text Add to dashboard Cite

show abstract

“…Rajagopalan et al, reported an overall maternal mortality of 21% and fetal mortality of 10% and 35% for type A and B dissections [12].…”

Section: Discussionmentioning

confidence: 99%

Maternal Death Due to Acute Aortic Dissection-Autopsy Diagnosis: A Case Report

Kasap¹

2015

CSMC

View full text Add to dashboard Cite

“…6) The fetal mortality rate was reported to be as high as 35% in type B aortic dissections. 2,6,7) The reason for such a high fetal mortality may be that the extension of dissections affecting the internal iliac arteries results in uterine and placental hypoperfusion which leads to intrauterine fetal death. 2,4,5) Timely diagnosis and management are the keys to decrease fetal mortality.…”

Section: Discussionmentioning

confidence: 99%

“…The fetal mortality rate of type B dissection has been reported to be higher than that of type A, which is ascribed to the involvement of the internal iliac arteries. 2,3) Cesareans are usually performed before or after the aortic repair depending on the conditions of the mother and fetus, while there are few reports in the literature on vaginal delivery of a stillborn baby in pregnant women with an aortic dissection. Here we report our experience in treating a 32-week pregnant woman with a ruptured type B aortic dissection, whose baby had died before admission.…”

mentioning

confidence: 99%

A Vaginal Stillbirth after Aortic Surgery of Type B Aortic Dissection in a Pregnant Woman

et al. 2018

View full text Add to dashboard Cite

SummaryAcute aortic dissection occurring during pregnancy poses great danger to both the mother and fetus. Cesareans are usually performed before or after the aortic repair depending on the conditions of the mother and fetus. Here we report our experience in treating a 32-week pregnant woman with a type B aortic dissection, whose baby had died before admission. A cesarean section was initially arranged after emergency aortic repair. However, the patient started to deliver the fetus vaginally after the aortic surgery and the stillborn baby was delivered vaginally. This case report provides new insight into the method of delivery in a pregnant woman with an aortic dissection.(Int Heart J 2018; 59: 448-450) Key words: Thoracic aortic aneurysm and pregnancy, Stillborn, Treatment A cute aortic dissection occurring during pregnancy poses a great danger to both the mother and fetus. Without timely management, more than 50% of the patients will die within 48 hours.1) The maternal and fetal mortality rates from acute aortic dissection remain high. The fetal mortality rate of type B dissection has been reported to be higher than that of type A, which is ascribed to the involvement of the internal iliac arteries.2,3) Cesareans are usually performed before or after the aortic repair depending on the conditions of the mother and fetus, while there are few reports in the literature on vaginal delivery of a stillborn baby in pregnant women with an aortic dissection. Here we report our experience in treating a 32-week pregnant woman with a ruptured type B aortic dissection, whose baby had died before admission. A cesarean section was initially planned after an emergent aortic repair. However, the patient started her vaginal stillborn delivery immediately after aortic surgery and the stillborn baby was delivered vaginally. This case report provides new insight into the method of delivery in a pregnant woman with an aortic dissection, showing that vaginal stillborn delivery can be started under such conditions. Case ReportA 30-year-old G3P2 pregnant woman at 32 weeks gestation, diagnosed with an acute type B aortic dissection, came to our emergency department after sudden tearing pain which radiated into her chest and back. She was diagnosed with a "stomachache" in a rural community hospital. The pain did not weaken even after she took analgesics and antispasmodics. She went to a larger hospital and lost conscious for several minutes upon arriving at the hospital. Norepinephrine was used to increase her blood pressure. After that she felt no movement in her fetus, which was 24 hours after the initial pain. Fetal heart sounds were absent. Ultrasound scanning confirmed that the baby had died (Figure 1). Another CT showed that she had a type B aortic dissection, which had ruptured into the thorax and the true lumen was severely compressed (Figure 2). She was then transferred to our hospital about 40 hours after onset of the pain.At admission she exhibited dyspnea and anuria. On examination her vital signs were unstable. She was tach...

show abstract

Outcomes in pregnant women with acute aortic dissections: a review of the literature from 2003 to 2013

Cited by 77 publications

References 82 publications

Peripartum Type A Aortic Dissection Repair Using Frozen Elephant Trunk Technique

Peripartum Type A Aortic Dissection Repair Using Frozen Elephant Trunk Technique

Maternal Death Due to Acute Aortic Dissection-Autopsy Diagnosis: A Case Report

A Vaginal Stillbirth after Aortic Surgery of Type B Aortic Dissection in a Pregnant Woman

Contact Info

Product

Resources

About