Clinical analysis of 24 cases of aortic dissection during pregnancy

Abstract

Objective: To investigate the management and perinatal outcome of aortic dissection during pregnancy. Methods: 24 pregnant women with aortic dissection who delivered in Beijing Anzhen Hospital Affiliated to Capital Medical University from January 1st, 2006 to February 29th, 2016 were recruited. The clinical data, the management and the perinatal outcome were analyzed retrospectively. Results: (1) Clinical features: The average age of the patients was (29±4) years old. The clinical symptoms occurred from 5 gestational weeks to 1 month after delivery. The major symptoms were chest pain, and some complained migratory or radiating pains. There were 17 Stanford type A cases and 7 type B cases. The aortic widths were 2.9-10.0 cm, with the average of (5.6±1.7) cm. D-dimer level was 448-6 421 μg/L, with the average of (1 097±1 209) μg/L, and the fibrin degradation products were 4.1-52.1 mg/L, with the average of (10.2±9.5) mg/L.The white blood cell ranged (6.8-36.4)×10(9)/L, with the average of (29.4±4.2)×10(9)/L; and the neutrophil rate was 76.0%-97.6%, with the average of (84.6±6.3) %. (2) The treatment: ①19 patients underwent aorta surgeries. The surgeries included aortic root replacement with total aortic arch replacement plus stented elephant trunk implantation (Bentall+Sun's surgery), aortic root replacement (Bentall surgery), stent implantation, thoracic and abdominal aorta replacement. The aortic operation time of the 19 patients were 5 gestational weeks to 1 month after delivery. The relation between aortic operation and the termination of pregnancy: 4 patients underwent aorta surgery after termination of pregnancy, 9 patients had cesarean section and aorta surgery at the same time, 6 patients underwent aorta surgery before cesarean section. ② 5 patients did not receive arota surgery, 2 patients of type A dissection and 1 patient of type B dissection died before the surgery; 2 cases of type B dissection underwent conservative treatment. The termination time of pregnancy was 6-37 gestational weeks, with the average of (26±10) weeks. (3)Maternal and fetal outcomes: 20 patients survived after treatment (83%, 20/24) and 4 patients died (17%, 4/24). 10 cases were live births, including 4 full-term infants and 6 preterm premature infants. The birth weight of the neonates was 1 080-3 800 g, with the average of (2 302±764) g. Three of them were very low birth weight infants and 1 was low birth weight infant; 3 neonates had mild asphyxia. The neonates were followed up for 0.5 to 10 years, with the average time of (1.4±1.7) years. So far the infants' development was good. Conclusions: Pregnancy with aortic dissection is pernicious. Early identification, prompt diagnosis and prompt interventing of the vascular surgery are necessary to the safety of mother and fetus.