open access

Vol 90, No 6 (2019)
REVIEW PAPERS Obstetrics
Published online: 2019-06-28
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Aortic dissection during pregnancy — obstetric perspective

Elzbieta Poniedzialek-Czajkowska, Agata Sadowska, Radzislaw Mierzynski, Bozena Leszczynska-Gorzelak
DOI: 10.5603/GP.2019.0052
·
Pubmed: 31276187
·
Ginekol Pol 2019;90(6):346-350.

open access

Vol 90, No 6 (2019)
REVIEW PAPERS Obstetrics
Published online: 2019-06-28

Abstract

The risk of vascular events during pregnancy is substantially increased. Beyond comparatively frequent vascular diseases, pregnancy may lead also to the development of exceptionally rare vascular events such as the aortic dissection and aortic rupture which are conceivably endangering life conditions. Women with the connective tissue disorders and with a family history of the aorta diseases are especially prone to the aortic complications which may also develop in the absence of these risk factors due to the pregnancy-induced structural changes of the aortic wall. The preconception counselling is vital for patients with aortopathies to assess the risk of the aortic dissection and to establish the most appropriate care plan including the surgical intervention. This review presents the management guidelines in patients with the aortic dissection risk during pregnancy.

Abstract

The risk of vascular events during pregnancy is substantially increased. Beyond comparatively frequent vascular diseases, pregnancy may lead also to the development of exceptionally rare vascular events such as the aortic dissection and aortic rupture which are conceivably endangering life conditions. Women with the connective tissue disorders and with a family history of the aorta diseases are especially prone to the aortic complications which may also develop in the absence of these risk factors due to the pregnancy-induced structural changes of the aortic wall. The preconception counselling is vital for patients with aortopathies to assess the risk of the aortic dissection and to establish the most appropriate care plan including the surgical intervention. This review presents the management guidelines in patients with the aortic dissection risk during pregnancy.

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Keywords

aortopathy; aortic dissection; Marfan syndrome; pregnancy

About this article
Title

Aortic dissection during pregnancy — obstetric perspective

Journal

Ginekologia Polska

Issue

Vol 90, No 6 (2019)

Pages

346-350

Published online

2019-06-28

DOI

10.5603/GP.2019.0052

Pubmed

31276187

Bibliographic record

Ginekol Pol 2019;90(6):346-350.

Keywords

aortopathy
aortic dissection
Marfan syndrome
pregnancy

Authors

Elzbieta Poniedzialek-Czajkowska
Agata Sadowska
Radzislaw Mierzynski
Bozena Leszczynska-Gorzelak

References (25)
  1. Nasiell J, Lindqvist P. Aortic dissection in pregnancy: the incidence of a life-threatening disease. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2010; 149(1): 120–121.
  2. Kamel H, Roman MJ, Pitcher A, et al. Pregnancy and the Risk of Aortic Dissection or Rupture: A Cohort-Crossover Analysis. Circulation. 2016; 134(7): 527–533.
  3. Jayaram A, Carp HM, Davis L, et al. Pregnancy complicated by aortic dissection: caesarean delivery during extradural anaesthesia. Br J Anaesth. 1995; 75(3): 358–360.
  4. Yuan SM. Aortic dissection during pregnancy: a difficult clinical scenario. Clin Cardiol. 2013; 36(10): 576–584.
  5. Braverman AC. Acute aortic dissection: clinician update. Circulation. 2010; 122(2): 184–188.
  6. Smok DA. Aortopathy in pregnancy. Semin Perinatol. 2014; 38(5): 295–303.
  7. Morgan J. Dissection of a complicated pregnancy. Aortic dissection in pregnancy is a rare, although not unheard of, complication. EMS Mag. 2008; 37(9): 68–70.
  8. Nataf P, Lansac E. Dilation of the thoracic aorta: medical and surgical management. Heart. 2006; 92(9): 1345–1352.
  9. 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.
  10. Easterling TR, Benedetti TJ, Schmucker BC, et al. Maternal hemodynamics and aortic diameter in normal and hypertensive pregnancies. Obstet Gynecol. 1991; 78(6): 1073–1077.
  11. Erbel R, Aboyans V, Boileau C, et al. Authors/Task Force members, ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(41): 2873–2926.
  12. Wanga S, Silversides C, Dore A, et al. Pregnancy and Thoracic Aortic Disease: Managing the Risks. Can J Cardiol. 2016; 32(1): 78–85.
  13. Vaideeswar P, Pandit SP, Patwardhan AM. Acute aortic dissection in pregnancy. Indian Heart J. 2004; 56(4): 354–355.
  14. Braverman AC. Aortic dissection: prompt diagnosis and emergency treatment are critical. Cleve Clin J Med. 2011; 78(10): 685–696.
  15. Thorne SA. Pregnancy in heart disease. Heart. 2004; 90(4): 450–456.
  16. Hiratzka LF, Bakris GL, Beckman JA, et al. 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, Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: 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. Circulation. 2010; 121(13): e266–e369.
  17. Pacini L, Digne F, Boumendil A, et al. Maternal complication of pregnancy in Marfan syndrome. Int J Cardiol. 2009; 136(2): 156–161.
  18. Keane MG, Pyeritz RE. Medical management of Marfan syndrome. Circulation. 2008; 117(21): 2802–2813.
  19. Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, et al. European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), ESC Committee for Practice Guidelines. 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.
  20. 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.
  21. Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest. 2002; 122(1): 311–328.
  22. Zeebregts C, Schepens M, Hameeteman T, et al. Acute Aortic Dissection Complicating Pregnancy. The Annals of Thoracic Surgery. 1997; 64(5): 1345–1348.
  23. Haas S, Trepte C, Rybczynski M, et al. Type A aortic dissection during late pregnancy in a patient with Marfan syndrome. Can J Anaesth. 2011; 58(11): 1024–1028.
  24. Guo C, Xu D, Wang C. Successful treatment for acute aortic dissection in pregnancy---Bentall procedure concomitant with cesarean section. J Cardiothorac Surg. 2011; 6: 139.
  25. Svensson LG, Kouchoukos NT, Miller DC, et al. Society of Thoracic Surgeons Endovascular Surgery Task Force. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg. 2008; 85(1 Suppl): S1–41.

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