Peripartum acute aortic dissection in a single centre: Experience in 9 patients

Objective: Spontaneous acute aortic dissection in pregnancy is a rare, life-threatening condition for both the mother and the fetus. Most commonly, it is associated with connective tissue disorders, cardiac valve variants, hypertension or trauma. In order to increase the awareness of this hazardous condition, we have summarized findings from 9 cases from our center.

Methods: Between June 1998 and December 2010, 9 pregnant women were diagnosed with acute aortic dissection. Computed tomography showed a type A aortic dissection in 6 patients and type B in 3. Predisposing factors consisted of hypertension (n = 5), a family history of aortic dissection (n = 4), Marfan syndrome, Ehler-Danlos syndrome and bicuspid aortic valve disease in 1 patient each.

Results: Mean age was 33 ± 5 years (range 24 – 39) and 4 patients presented during their first pregnancy. Seven patients presented in pre-partum phase with mean gestation time of 27 ± 11 week, and 2 patients in the post-partum phase (at 2^nd day and 6^th day). All 9 patients underwent surgical repair. Mean CBP time was 214 ± 47.4 minutes and aortic cross-clamp time was 96.3 ± 38.3 minutes. Circulatory arrest was required in 7 patients for 27 ± 11 minutes, using a temperature range of 20 – 28 °C. A Bentall operation was performed in 4 patients, a Yacoub valve sparing procedure in 2, David valve reimplantation in 1 and an isolated ascending aorta replacement in 2 patients. Total arch replacement was performed in 3 patients (1 as elephant trunk) and partial arch replacement in 4. Two of the 3 patients with a diagnosis of type B aortic dissection underwent a thoracic-abdominal aorta replacement at the time of presentation and a stent implantation 7 days after, respectively. In 4 cases the infants was delivered by cesarean section prior the surgical procedure and 1 immediately after surgery. Neurological complications occurred in 2 patients and one experienced mesenteric ischemia. One patient died of descending aortic rupture 15 days post-operatively. All other patients (89%) are currently alive.

Conclusions: Acute aortic dissection can be successfully treated with cardiopulmonary bypass without maternal or fetal death in the majority of patients. An aggressive approach to treat these patients by surgery is indicated and simultaneous cesarean section is a good option.