Successful management of acute type A aortic dissection in late pregnancy: a case report

Stanford Type A aortic dissection (TAAD) complicating pregnancy is exceedingly rare yet catastrophic, representing a leading cause of maternal cardiovascular mortality. Management requires balancing maternal hemodynamic stability and fetal viability.

A 31-year-old woman (G2P0) at 38 weeks gestation presented with acute tearing chest pain. Computed tomography angiography confirmed TAAD extending from ascending aorta to proximal arch, and the right coronary artery was affected. Transthoracic echocardiography confirmed TAAD with aortic sinus dilation (40 mm) and moderate aortic regurgitation. Multidisciplinary management included emergency cesarean section delivering a healthy female infant (Apgar 9/9/10), followed by prophylactic uterine artery embolization to mitigate hemorrhage risk during subsequent cardiac surgery. The patient underwent Bentall procedure combined with coronary artery bypass grafting. The patient recovered uneventfully, discharged on postoperative day 14. Two-month follow-up demonstrated adequate aortic remodeling with regional residual distal dissection.

This case demonstrates that a sequential surgical approach with multidisciplinary collaboration can optimize outcomes in late pregnancy complicated by TAAD.