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Acute aortic dissection complicating pregnancy

C J Zeebregts1, M A Schepens, T M Hameeteman

  • 1Department of Cardiopulmonary Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.

The Annals of Thoracic Surgery
|December 5, 1997
PubMed
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Acute aortic dissection in pregnancy is dangerous. Combined cesarean and aortic repair is recommended for Type A, while Type B dissection management varies, with no maternal deaths reported.

Area of Science:

  • Cardiovascular Surgery
  • Maternal-Fetal Medicine
  • Aortic Diseases

Background:

  • Acute aortic dissection during pregnancy poses a severe risk to both mother and fetus.
  • This rare condition necessitates understanding its prevalence, treatment, and outcomes.

Purpose of the Study:

  • To investigate the prevalence, treatments, and outcomes of acute aortic dissection in pregnant women.
  • To propose therapeutic guidelines for managing this critical condition.

Main Methods:

  • A retrospective review of 6 pregnant women with acute aortic dissection over 12 years.
  • Classification of dissections into Type A (4 patients) and Type B (2 patients) based on the Stanford criteria.

Main Results:

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  • Four Type A dissection patients underwent combined cesarean section and aortic repair, with all 4 fetuses delivered alive (3 long-term survivors).
  • Two Type B dissection patients had fetal demise; one received medical treatment, the other surgery for celiac ischemia.
  • No maternal deaths occurred in either group.

    • Conclusions:

    • Cesarean section with concurrent aortic repair is advised for Type A dissection, with procedure timing dependent on gestational age and maternal hemodynamics.
    • Medical management is recommended for Type B dissection, with surgical intervention reserved for complications like bleeding or malperfusion.
    • The study suggests specific management strategies to improve maternal and fetal outcomes in pregnancy-associated aortic dissection.