Type B Dissection in a Pregnant Woman Managed With Peripartum Thoracic Endovascular Aortic Repair

Abstract

A 39-year-old woman (gravida 2, para 1-0-0-1) with no medical history developed acute, tearing chest pain radiating to her back, which reached maximal intensity within minutes of onset. She was then 31 weeks into an uncomplicated pregnancy with no evidence of pre-eclampsia or systemic hypertension. Routine prenatal care was pursued throughout the pregnancy, and testing for HIV infection and syphilis was negative. Vital signs on presentation to her local emergency department were notable for a blood pressure of 129/55 mm Hg and troponin I levels that were undetectable (<0.04 ng/mL) on serial evaluations. A computed tomography pulmonary angiogram revealed a type B aortic dissection (Figure 1) that extended to the aortic bifurcation (Figure 2). She was subsequently transferred to our institution where transthoracic echocardiography showed the dissection flap in the descending aorta (Figure 3 and Movie I in the online-only Data Supplement), an aortic sinus and ascending aorta within normal limits of size (3.7 and 2.9 cm, respectively), no evidence of aortic coarctation, and a trileaflet aortic valve. Color-flow Doppler revealed more prominent flow in the true lumen than in the false lumen (Figure 4 and Movie …