Type A aortic dissection during late pregnancy in a patient with Marfan syndrome

Abstract

To report the management of a 38-yr-old patient with known Marfan syndrome who presented with acute Stanford type A dissection of the aorta in the 34(th) week of pregnancy. A Cesarean delivery was performed under deep general anesthesia with high-dose opioid administration to avoid tachycardia and hypertension during tracheal intubation and obstetric surgery. Delivery took place less than five minutes after induction of anesthesia, and tracheal intubation of the newborn was required due to opioid-induced hypoventilation. Subsequently, aortic arch repair was performed in the mother after connection to extracorporal bypass. Despite extensive replacement of coagulation factors, severe vaginal bleeding persisted after weaning from extracorporal bypass, and the bleeding stopped only after a hysterectomy was performed. Postoperatively, after a short period in the intensive care unit, mother and child were discharged from hospital in excellent condition ten days after surgery. Deep general anesthesia for emergency Cesarean delivery while accepting the risk of respiratory depression in the newborn is a viable option for the anesthetic management of life-threatening events such as Stanford type A dissection.