Multidisciplinary management of acute type A aortic dissection in late pregnancy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Lingchao , LI Tianbo , LIU Chencheng , XU Bo , XIAO Yingbin ,  WANG Yong

Institute of Cardiovascular Surgery, Xinqiao Hospital, Army Medical University, Chongqing, 400037, P.R.China;

Corresponding author：

WANG Yong, Email: wy003236@163.com

Keywords：

Aortic dissection; pregnancy; multiple disciplines; treatment

DOI：

10.7507/1007-4848.202007097

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the multidisciplinary management of patients with acute type A aortic dissection in late pregnancy.Methods The clinical data of 3 patients admitted to the Second Affiliated Hospital of Army Medical University from 2018 to 2019 were analyzed. Their age ranged from 27 to 32 years, while gestational age was 34-37 weeks. Sudden chest pain was the main clinical symptom before operation. All 3 patients underwent Bentall surgery after cesarean section under general anesthesia, of whom 2 patients received total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and 1 received coronary artery bypass grafting (CABG) additionally.Results No patient died during the perioperative period, and all the newborns were delivered successfully and survived healthily. The ICU stay was 3-5 d. The postoperative hospital stay was 15-18 d. The follow-up was 250-751 d. There was no recurrence or death. One patient who developed spontaneous pneumothorax and hydropneumothorax was cured in our center.Conclusion The multidisciplinary diagnosis and treatment strategy plays a crucial role in saving the life of pregnant patients with acute type A aortic dissection.

Citation： LIU Lingchao, LI Tianbo, LIU Chencheng, XU Bo, XIAO Yingbin, WANG Yong. Multidisciplinary management of acute type A aortic dissection in late pregnancy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1488-1493. doi: 10.7507/1007-4848.202007097 Copy

1.	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.
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.	Ch'ng SL, Cochrane AD, Goldstein J, et al. Stanford type A aortic dissection in pregnancy: A diagnostic and management challenge. Heart Lung Circ, 2013, 22(1): 12-18.
4.	Sawlani N, Shroff A, Vidovich MI. Aortic dissection and mortality associated with pregnancy in the United States. J Am Coll Cardiol, 2015, 65(15): 1600-1601.
5.	Cantwell R, Clutton-Brock T, Cooper G, et al. Saving mothers' lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG, 2011, 118 (Suppl 1): 1-203.
6.	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.
7.	Smok DA. Aortopathy in pregnancy. Semin Perinatol, 2014, 38(5): 295-303.
8.	Ramlakhan KP, Johnson MR, Roos-Hesselink JW. Pregnancy and cardiovascular disease. Nat Rev Cardiol, 2020, 17(11): 718-731.
9.	Crawford JD, Hsieh CM, Schenning RC, et al. Genetics, pregnancy, and aortic degeneration. Ann Vasc Surg, 2016, 30: 158.
10.	Manalo-Estrella P, Barker AE. Histopathologic findings in human aortic media associated with pregnancy. Arch Pathol, 1967, 83(4): 336-341.
11.	Meijboom LJ, Vos FE, Timmermans J, et al. Pregnancy and aortic root growth in the Marfan syndrome: A prospective study. Eur Heart J, 2005, 26(9): 914-920.
12.	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.
13.	Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: Diagnosis and management, an update. Eur Heart J, 2018, 39(9): 739-749.
14.	Patel C, Akhtar H, Gupta S, et al. Pregnancy and cardiac interventions: What are the optimal management options? J Card Surg, 2020, 35(7): 1589-1596.
15.	Hiraya D, Sato A, Aonuma K. Circulating microRNAs as an emerging biomarker for acute aortic dissection diagnosis-comparing with prior biomarkers. J Thorac Dis, 2018, 10(3): 1186-1189.
16.	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.
17.	van Hagen IM, Cornette J, Johnson MR, et al. Managing cardiac emergencies in pregnancy. Heart, 2017, 103(2): 159-173.
18.	Liu Y, Han F, Zhuang J, et al. Cardiac operation under cardiopulmonary bypass during pregnancy. J Cardiothorac Surg, 2020, 15(1): 92.
19.	Regitz-Zagrosek V, Blomstrom L C, Borghi C, 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.
20.	Bingel U, Wanigasekera V, Wiech K, et al. The effect of treatment expectation on drug efficacy: Imaging the analgesic benefit of the opioid remifentanil. Sci Transl Med, 2011, 3(70): 70ra14.
21.	Noskova P, Blaha J, Bakhouche H, et al. Neonatal effect of remifentanil in general anaesthesia for caesarean section: A randomized trial. BMC Anesthesiol, 2015, 15: 38.
22.	Kuroda Y, Uchida T, Hamasaki A, et al. Surgery for acute type A aortic dissection in a pregnant woman at 28 weeks' gestation. Braz J Cardiovasc Surg, 2019, 34(5): 627-629.
23.	李文莉, 邓继红, 张雯. 不同手术方法治疗子宫肌瘤对术后患者内分泌状态影响的研究. 中国卫生标准管理, 2020, 11(14): 84-86.
24.	Paparella D, Rotunno C, Guida P, et al. Hemostasis alterations in patients with acute aortic dissection. Ann Thorac Surg, 2011, 91(5): 1364-1369.
25.	Guan XL, Wang XL, Liu YY, et al. Changes in the hemostatic system of patients with acute aortic dissection undergoing aortic arch surgery. Ann Thorac Surg, 2016, 101(3): 945-951.
26.	Ler A, Sazzad F, Ong GS, et al. Comparison of outcomes of the use of Del Nido and St. Thomas cardioplegia in adult and paediatric cardiac surgery: A systematic review and meta-analysis. Perfusion, 2020, 35(8): 724-735.
27.	Kuserli Y, Turkyilmaz S, Turkyilmaz G, et al. Comparison of del Nido cardioplegia and blood cardioplegia in aortic root surgery. Heart Surg Forum, 2020, 23(3): E376-E384.
28.	Schmidt AF, Kemp MW, Rittenschober-Böhm J, et al. Low-dose betamethasone-acetate for fetal lung maturation in preterm sheep. Am J Obstet Gynecol, 2018, 218(1): 131-132.
29.	Shaw OEF, Yager JY. Preventing childhood and lifelong disability: Maternal dietary supplementation for perinatal brain injury. Pharmacol Res, 2019, 139: 228-242.
30.	Zhu JM, Ma WG, Peterss S, et al. Aortic dissection in pregnancy: Management strategy and outcomes. Ann Thorac Surg, 2017, 103(4): 1199-1206.
31.	Kapoor MC. Cardiopulmonary bypass in pregnancy. Ann Card Anaesth, 2014, 17(1): 33-39.
32.	李欣, 张洪宇, 韩凤珍, 等. 妊娠合并急性Stanford A型主动脉夹层的处置策略. 南方医科大学学报, 2017, 37(11): 1555-1558.

1. 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.
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. Ch'ng SL, Cochrane AD, Goldstein J, et al. Stanford type A aortic dissection in pregnancy: A diagnostic and management challenge. Heart Lung Circ, 2013, 22(1): 12-18.
4. Sawlani N, Shroff A, Vidovich MI. Aortic dissection and mortality associated with pregnancy in the United States. J Am Coll Cardiol, 2015, 65(15): 1600-1601.
5. Cantwell R, Clutton-Brock T, Cooper G, et al. Saving mothers' lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG, 2011, 118 (Suppl 1): 1-203.
6. 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.
7. Smok DA. Aortopathy in pregnancy. Semin Perinatol, 2014, 38(5): 295-303.
8. Ramlakhan KP, Johnson MR, Roos-Hesselink JW. Pregnancy and cardiovascular disease. Nat Rev Cardiol, 2020, 17(11): 718-731.
9. Crawford JD, Hsieh CM, Schenning RC, et al. Genetics, pregnancy, and aortic degeneration. Ann Vasc Surg, 2016, 30: 158.
10. Manalo-Estrella P, Barker AE. Histopathologic findings in human aortic media associated with pregnancy. Arch Pathol, 1967, 83(4): 336-341.
11. Meijboom LJ, Vos FE, Timmermans J, et al. Pregnancy and aortic root growth in the Marfan syndrome: A prospective study. Eur Heart J, 2005, 26(9): 914-920.
12. 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.
13. Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: Diagnosis and management, an update. Eur Heart J, 2018, 39(9): 739-749.
14. Patel C, Akhtar H, Gupta S, et al. Pregnancy and cardiac interventions: What are the optimal management options? J Card Surg, 2020, 35(7): 1589-1596.
15. Hiraya D, Sato A, Aonuma K. Circulating microRNAs as an emerging biomarker for acute aortic dissection diagnosis-comparing with prior biomarkers. J Thorac Dis, 2018, 10(3): 1186-1189.
16. 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.
17. van Hagen IM, Cornette J, Johnson MR, et al. Managing cardiac emergencies in pregnancy. Heart, 2017, 103(2): 159-173.
18. Liu Y, Han F, Zhuang J, et al. Cardiac operation under cardiopulmonary bypass during pregnancy. J Cardiothorac Surg, 2020, 15(1): 92.
19. Regitz-Zagrosek V, Blomstrom L C, Borghi C, 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.
20. Bingel U, Wanigasekera V, Wiech K, et al. The effect of treatment expectation on drug efficacy: Imaging the analgesic benefit of the opioid remifentanil. Sci Transl Med, 2011, 3(70): 70ra14.
21. Noskova P, Blaha J, Bakhouche H, et al. Neonatal effect of remifentanil in general anaesthesia for caesarean section: A randomized trial. BMC Anesthesiol, 2015, 15: 38.
22. Kuroda Y, Uchida T, Hamasaki A, et al. Surgery for acute type A aortic dissection in a pregnant woman at 28 weeks' gestation. Braz J Cardiovasc Surg, 2019, 34(5): 627-629.
23. 李文莉, 邓继红, 张雯. 不同手术方法治疗子宫肌瘤对术后患者内分泌状态影响的研究. 中国卫生标准管理, 2020, 11(14): 84-86.
24. Paparella D, Rotunno C, Guida P, et al. Hemostasis alterations in patients with acute aortic dissection. Ann Thorac Surg, 2011, 91(5): 1364-1369.
25. Guan XL, Wang XL, Liu YY, et al. Changes in the hemostatic system of patients with acute aortic dissection undergoing aortic arch surgery. Ann Thorac Surg, 2016, 101(3): 945-951.
26. Ler A, Sazzad F, Ong GS, et al. Comparison of outcomes of the use of Del Nido and St. Thomas cardioplegia in adult and paediatric cardiac surgery: A systematic review and meta-analysis. Perfusion, 2020, 35(8): 724-735.
27. Kuserli Y, Turkyilmaz S, Turkyilmaz G, et al. Comparison of del Nido cardioplegia and blood cardioplegia in aortic root surgery. Heart Surg Forum, 2020, 23(3): E376-E384.
28. Schmidt AF, Kemp MW, Rittenschober-Böhm J, et al. Low-dose betamethasone-acetate for fetal lung maturation in preterm sheep. Am J Obstet Gynecol, 2018, 218(1): 131-132.
29. Shaw OEF, Yager JY. Preventing childhood and lifelong disability: Maternal dietary supplementation for perinatal brain injury. Pharmacol Res, 2019, 139: 228-242.
30. Zhu JM, Ma WG, Peterss S, et al. Aortic dissection in pregnancy: Management strategy and outcomes. Ann Thorac Surg, 2017, 103(4): 1199-1206.
31. Kapoor MC. Cardiopulmonary bypass in pregnancy. Ann Card Anaesth, 2014, 17(1): 33-39.
32. 李欣, 张洪宇, 韩凤珍, 等. 妊娠合并急性Stanford A型主动脉夹层的处置策略. 南方医科大学学报, 2017, 37(11): 1555-1558.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Multidisciplinary management of acute type A aortic dissection in late pregnancy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content