Acute aortic dissection during pregnancy: Trials and tribulations

Area of Science:

• Cardiovascular Surgery
• Maternal-Fetal Medicine
• Aortic Diseases

Background:

• Pregnancy is an independent risk factor for Type A acute aortic dissection (TAAD) due to physiological hyperdynamic circulation.
• TAAD in pregnancy poses a significant threat to both maternal and fetal well-being.
• Current understanding and management strategies for this condition remain controversial.

Purpose of the Study:

• To review and discuss the current controversies surrounding Type A acute aortic dissection (TAAD) in pregnant patients.
• To provide an overview of the challenges and considerations in managing TAAD during pregnancy.
• To highlight areas requiring further research to improve outcomes.

Main Methods:

• A comprehensive literature search was conducted across major databases.
• Relevant studies focusing on acute aortic dissection in pregnant women were assimilated.
• The review synthesizes existing evidence and expert opinions on the topic.

Main Results:

• TAAD in pregnancy can present atypically, leading to delayed diagnosis due to concerns about fetal radiation exposure.
• Prompt imaging (CT, MRI, TEE) is crucial given the high mortality risk.
• Surgical management decisions involve balancing maternal repair with fetal delivery timing.

Conclusions:

• Management requires rapid, dynamic assessment and intervention without delay.
• Operative techniques and cardiopulmonary bypass pose risks to the fetus, necessitating cautious approaches.
• Further research is essential to reduce maternal and fetal mortality in TAAD during pregnancy.