Aortic dissection in the first trimester; is it a dead end? A narrative review of recent articles

J Card Surg. 2022 Jun;37(6):1705-1711. doi: 10.1111/jocs.16451. Epub 2022 Mar 29.

Abstract

Introduction: Acute-type aortic dissection (AD) during pregnancy is considered a rare and potentially fatal complication for both mother and fetus. Although the definite treatment for an acute-type AD is considered to be open-heart surgery, the decision to perform such a surgery during pregnancy requires a multidisciplinary approach and carries significant risks.

Methods: In the present review of the literature, we have discussed various challenges in the management of acute-type AD during pregnancy, including therapeutic approaches, choosing the preferred imaging modalities, surgical techniques, and medication challenges. We have also reported an 8-week pregnant woman with Marfan syndrome who presented with chest pain and was diagnosed with acute AD.

Results: The patient underwent a Bentall operation and was discharged in good condition with her fetus alive. The medical team's various decisions during preoperative, operative, and postoperative treatments were discussed.

Conclusions: Type A AD is considered infrequent in the second and third trimester of pregnancy and rare in the first trimester. Performing a CMR study without contrast in stable patients can help evaluate the extension of the flap. Urgent surgery in the hands of a skilled surgeon may prove lifesaving for the mother while maximizing the likelihood of preserving the fetus.

Keywords: aorta and great vessels; cardiovascular research; valve repair/replacement.

Publication types

  • Review

MeSH terms

  • Aortic Aneurysm* / surgery
  • Aortic Dissection* / diagnosis
  • Female
  • Humans
  • Marfan Syndrome* / complications
  • Marfan Syndrome* / diagnosis
  • Marfan Syndrome* / surgery
  • Pregnancy
  • Pregnancy Complications, Cardiovascular* / surgery
  • Pregnancy Trimester, First