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Related Experiment Videos

Aortic disease associated with pregnancy.

G M Williams1, V L Gott, R K Brawley

  • 1Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21205.

Journal of Vascular Surgery
|October 1, 1988
PubMed
Summary

Managing life-threatening aortic disease in pregnancy requires careful timing. Cesarean delivery followed by aortic repair is often successful for both mother and fetus, especially in later pregnancy.

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Area of Science:

  • Cardiovascular Surgery
  • Maternal-Fetal Medicine
  • Genetics

Background:

  • Pregnancy significantly increases the risk of aortic dissection and aneurysm expansion, particularly in women with connective tissue disorders like Ehlers-Danlos syndrome type IV or Marfan syndrome.
  • Aortic emergencies during pregnancy pose a dual threat to both the mother and the fetus, necessitating specialized management strategies.

Observation:

  • Two cases of life-threatening aortic disease during pregnancy are presented: one due to trauma-induced intimal disruption and another with acute descending thoracic aortic dissection likely due to Ehlers-Danlos type IV syndrome.
  • Successful management involved emergent cesarean section followed by Dacron graft replacement of the descending thoracic aorta, preserving both maternal and fetal well-being.

Findings:

  • Aortic dissections in women under 40 frequently occur during pregnancy, with peak incidence during the third trimester and labor/delivery.

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  • Surgical repair of pre-existing aortic disease is recommended during the first or second trimester, with subsequent delivery via cesarean section.
  • Acute aortic events near term are best managed with prompt cesarean delivery followed by aortic intervention.

    • Implications:

    • This approach highlights the importance of multidisciplinary care for pregnant patients with aortic conditions.
    • Timely surgical intervention and delivery strategies can significantly improve outcomes for mother and child in high-risk pregnancies.
    • Early diagnosis and management of aortic disease in pregnant individuals are crucial for preventing catastrophic events.