Diagnosis and treatment for pregnancy with aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Sishu ¹ ,  QIAN Yongjun ² , LIANG Weitao ² , LI Tao ²

1. West China Clinical Medical College, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Cardiovascular Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

QIAN Yongjun, Email: yongjunqian@sina.com

Keywords：

Pregnancy; Marfan syndrome; aortic dissection

DOI：

10.7507/1007-4848.201805047

Video：

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Aortic dissection during pregnancy is rare in clinics. Because the symptoms are lack of specificity, early diagnosis is difficult. However, the progression of aortic dissection is fast, therefore, the mortality of pregnant women and fetuses is high, and half of the death in pregnant women is due to aortic dissection. Although the development of medical condition is rapid, aortic dissection of pregnancy is still a great challenge for patients and clinicians, and is one of the most important diseases in obstetric medical disputes. In this paper, combined with the literatures published in recent years, we summarized the epidemiological characteristics and related treatment suggestions of the aortic dissection in pregnancy.

Citation： YANG Sishu, QIAN Yongjun, LIANG Weitao, LI Tao. Diagnosis and treatment for pregnancy with aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(5): 499-503. doi: 10.7507/1007-4848.201805047 Copy

1.	Westhoff-Bleck M, Podewski E, Hilfiker A, et al. Cardiovascular disorders in pregnancy: diagnosis and management. Best Pract Res Clin Obstet Gynaecol, 2013, 27(6): 821-834.
2.	Liu YY, Li HY, Jiang WJ, et al. Treatment of patients with aortic disease during pregnancy and after delivery. J Int Med Res, 2017, 45(4): 1359-1368.
3.	Thalmann M, Sodeck GH, Domanovits H, et al. Acute type A aortic dissection and pregnancy: a population-based study. Eur J Cardiothorac Surg, 2011, 39(6): e159-e163.
4.	Kamel H, Roman MJ, Pitcher A. Pregnancy and the risk of aortic dissection or rupture: a cohort-crossover analysis. Circulation, 2016, 134(7): 527-533.
5.	Immer FF, Bansi AG, Immer-Bansi AS, et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Ann Thorac Surg, 2003, 76(1): 309-314.
6.	Yang G, Peng W, Zhao Q, et al. Aortic dissection in women during the course of pregnancy or puerperium: a report of 11 cases in central south China. Int J Clin Exp Med, 2015, 8(7): 11607-11612.
7.	Yuan SM. Aortic dissection during pregnancy: a difficult clinical scenario. Clin Cardiol, 2013, 36(10): 576-584.
8.	Omnes S, Jondeau G, Detaint D, et al. Pregnancy outcomes among women with Marfan syndrome. Int J Gynaecol Obstet, 2013, 122(3): 219-223.
9.	Finkelmeier BA, Marolda D. Aortic dissection. J Cardiovasc Nurs, 2001, 15(4): 15-24.
10.	Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
11.	Shihata M, Pretorius V, MacArthur R. Repair of an acute type A aortic dissection combined with an emergency cesarean section in a pregnant woman. Interact Cardiovasc Thorac Surg, 2008, 7(5): 938-940.
12.	Olsson C, Thelin S, Ståhle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation, 2006, 114(24): 2611-2618.
13.	Chang CY, Yang JM, Lam CW, et al. Successful management of aortic dissection in a patient with Marfan syndrome during pregnancy. Am J Obstet Gynecol, 2013, 208(2): e3-e6.
14.	Lichtman AD, Kjaer K. Combined cesarean delivery and repair of acute ascending and aortic arch dissection at 32 weeks of pregnancy. J Cardiothorac Vasc Anesth, 2013, 27(4): 731-734.
15.	Goland S, Elkayam U. Pregnancy and Marfan syndrome. Ann Cardiothorac Surg, 2017, 6(6): 642-653.
16.	Roman MJ, Pugh NL, Hendershot TP, et al. Aortic complications associated with pregnancy in Marfan syndrome: The NHLBI National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). J Am Heart Assoc, 2016, 5(8): pii: e004052.
17.	European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(24): 3147-3197.
18.	Goland S, Elkayam U. Cardiovascular problems in pregnant women with marfan syndrome. Circulation, 2009, 119(4): 619-623.
19.	Baumgartner H, Bonhoeffer P, De Groot NM, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J, 2010, 31(23): 2915-2957.
20.	Davies RR, Gallo A, Coady MA, et al. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg, 2006, 81(1): 169-177.
21.	Gama P, Pancas R, Antunes MJ. Ascending thoracic aorta aneurysm surgery and aortic valve repair during pregnancy. J Card Surg, 2009, 24(5): 547-548.
22.	Tutarel O, Lotz J, Roentgen P, et al. Pregnancy in a Marfan patient with pre-existing aortic dissection. Int J Cardiol, 2007, 114(2): E36-E37.
23.	Smith K, Gros B. Pregnancy-related acute aortic dissection in Marfan syndrome: A review of the literature. Congenit Heart Dis, 2017, 12(3): 251-260.
24.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv, 2010, 76(2): E43-E86.
25.	Boodhwani M, Andelfinger G, Leipsic J, et al. Canadian Cardiovascular Society position statement on the management of thoracic aortic disease. Can J Cardiol, 2014, 30(6): 577-589.
26.	Elkayam U, Goland S, Pieper PG, et al. High-risk cardiac disease in pregnancy: Part Ⅰ. J Am Coll Cardiol, 2016, 68(4): 396-410.
27.	Alwan S, Polifka JE, Friedman JM. Angiotensin Ⅱ receptor antagonist treatment during pregnancy. Birth Defects Res A Clin Mol Teratol, 2005, 73(2): 123-130.
28.	Rajagopalan S, Nwazota N, Chandrasekhar S. Outcomes in pregnant women with acute aortic dissections: a review of the literature from 2003 to 2013. Int J Obstet Anesth, 2014, 23(4): 348-356.
29.	Kallenbach K, Baraki H, Khaladj N, et al. Aortic valve-sparing operation in Marfan syndrome: what do we know after a decade? Ann Thorac Surg, 2007, 83(2): S764-S768.
30.	Shu C, Fang K, Dardik A, et al. Pregnancy-associated type B aortic dissection treated with thoracic endovascular aneurysm repair. Ann Thorac Surg, 2014, 97(2): 582-587.
31.	Taylor J. The 2010 version of the ESC guidelines for the management of grown-up adult congenital heart disease are discussed by guidelines task force chairman H. Baumgartner. Eur Heart J, 2010, 31(23): 2825-2826.
32.	Zhu JM, Ma WG, Peterss S, et al. Aortic dissection in pregnancy: management strategy and outcomes. Ann Thorac Surg, 2017, 103(4): 1199-1206.
33.	Barrus A, Afshar S, Sani S, et al. Acute type A aortic dissection and successful surgical repair in a woman at 21 weeks gestational pregnancy with maternal and fetal survival: a case report. J Cardiothorac Vasc Anesth, 2018, 32(3): 1487-1493.

1. Westhoff-Bleck M, Podewski E, Hilfiker A, et al. Cardiovascular disorders in pregnancy: diagnosis and management. Best Pract Res Clin Obstet Gynaecol, 2013, 27(6): 821-834.
2. Liu YY, Li HY, Jiang WJ, et al. Treatment of patients with aortic disease during pregnancy and after delivery. J Int Med Res, 2017, 45(4): 1359-1368.
3. Thalmann M, Sodeck GH, Domanovits H, et al. Acute type A aortic dissection and pregnancy: a population-based study. Eur J Cardiothorac Surg, 2011, 39(6): e159-e163.
4. Kamel H, Roman MJ, Pitcher A. Pregnancy and the risk of aortic dissection or rupture: a cohort-crossover analysis. Circulation, 2016, 134(7): 527-533.
5. Immer FF, Bansi AG, Immer-Bansi AS, et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Ann Thorac Surg, 2003, 76(1): 309-314.
6. Yang G, Peng W, Zhao Q, et al. Aortic dissection in women during the course of pregnancy or puerperium: a report of 11 cases in central south China. Int J Clin Exp Med, 2015, 8(7): 11607-11612.
7. Yuan SM. Aortic dissection during pregnancy: a difficult clinical scenario. Clin Cardiol, 2013, 36(10): 576-584.
8. Omnes S, Jondeau G, Detaint D, et al. Pregnancy outcomes among women with Marfan syndrome. Int J Gynaecol Obstet, 2013, 122(3): 219-223.
9. Finkelmeier BA, Marolda D. Aortic dissection. J Cardiovasc Nurs, 2001, 15(4): 15-24.
10. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
11. Shihata M, Pretorius V, MacArthur R. Repair of an acute type A aortic dissection combined with an emergency cesarean section in a pregnant woman. Interact Cardiovasc Thorac Surg, 2008, 7(5): 938-940.
12. Olsson C, Thelin S, Ståhle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation, 2006, 114(24): 2611-2618.
13. Chang CY, Yang JM, Lam CW, et al. Successful management of aortic dissection in a patient with Marfan syndrome during pregnancy. Am J Obstet Gynecol, 2013, 208(2): e3-e6.
14. Lichtman AD, Kjaer K. Combined cesarean delivery and repair of acute ascending and aortic arch dissection at 32 weeks of pregnancy. J Cardiothorac Vasc Anesth, 2013, 27(4): 731-734.
15. Goland S, Elkayam U. Pregnancy and Marfan syndrome. Ann Cardiothorac Surg, 2017, 6(6): 642-653.
16. Roman MJ, Pugh NL, Hendershot TP, et al. Aortic complications associated with pregnancy in Marfan syndrome: The NHLBI National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). J Am Heart Assoc, 2016, 5(8): pii: e004052.
17. European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(24): 3147-3197.
18. Goland S, Elkayam U. Cardiovascular problems in pregnant women with marfan syndrome. Circulation, 2009, 119(4): 619-623.
19. Baumgartner H, Bonhoeffer P, De Groot NM, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J, 2010, 31(23): 2915-2957.
20. Davies RR, Gallo A, Coady MA, et al. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg, 2006, 81(1): 169-177.
21. Gama P, Pancas R, Antunes MJ. Ascending thoracic aorta aneurysm surgery and aortic valve repair during pregnancy. J Card Surg, 2009, 24(5): 547-548.
22. Tutarel O, Lotz J, Roentgen P, et al. Pregnancy in a Marfan patient with pre-existing aortic dissection. Int J Cardiol, 2007, 114(2): E36-E37.
23. Smith K, Gros B. Pregnancy-related acute aortic dissection in Marfan syndrome: A review of the literature. Congenit Heart Dis, 2017, 12(3): 251-260.
24. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv, 2010, 76(2): E43-E86.
25. Boodhwani M, Andelfinger G, Leipsic J, et al. Canadian Cardiovascular Society position statement on the management of thoracic aortic disease. Can J Cardiol, 2014, 30(6): 577-589.
26. Elkayam U, Goland S, Pieper PG, et al. High-risk cardiac disease in pregnancy: Part Ⅰ. J Am Coll Cardiol, 2016, 68(4): 396-410.
27. Alwan S, Polifka JE, Friedman JM. Angiotensin Ⅱ receptor antagonist treatment during pregnancy. Birth Defects Res A Clin Mol Teratol, 2005, 73(2): 123-130.
28. Rajagopalan S, Nwazota N, Chandrasekhar S. Outcomes in pregnant women with acute aortic dissections: a review of the literature from 2003 to 2013. Int J Obstet Anesth, 2014, 23(4): 348-356.
29. Kallenbach K, Baraki H, Khaladj N, et al. Aortic valve-sparing operation in Marfan syndrome: what do we know after a decade? Ann Thorac Surg, 2007, 83(2): S764-S768.
30. Shu C, Fang K, Dardik A, et al. Pregnancy-associated type B aortic dissection treated with thoracic endovascular aneurysm repair. Ann Thorac Surg, 2014, 97(2): 582-587.
31. Taylor J. The 2010 version of the ESC guidelines for the management of grown-up adult congenital heart disease are discussed by guidelines task force chairman H. Baumgartner. Eur Heart J, 2010, 31(23): 2825-2826.
32. Zhu JM, Ma WG, Peterss S, et al. Aortic dissection in pregnancy: management strategy and outcomes. Ann Thorac Surg, 2017, 103(4): 1199-1206.
33. Barrus A, Afshar S, Sani S, et al. Acute type A aortic dissection and successful surgical repair in a woman at 21 weeks gestational pregnancy with maternal and fetal survival: a case report. J Cardiothorac Vasc Anesth, 2018, 32(3): 1487-1493.

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