Emergency Bentall Procedure for Acute Type A Aortic Dissection in a Patient With Preterm Twin Pregnancy

Acute type A aortic dissection complicating pregnancy typically occurs in the third trimester (50%-60%) or postpartum period (30%-50%). Decision for single-stage "deliver-then-repair" vs emergency aortic surgery with in utero protection is multifactorial. A 36-year-old woman with 25-week-gestation twins presented with chest pain radiating to back. Echocardiogram showed dilated root with severe regurgitation. Urgent aortogram revealed Stanford type A (DeBakey type II) aortic dissection from coronary sinuses to ascending aorta. The multidisciplinary team decided for a Bentall procedure, which was performed in 4 hours 35 minutes. The patient made an uneventful recovery and her healthy twins were delivered at 31 weeks gestation.