Aortic Dissection in the First Trimester; Is It a Dead End? a Narrative Review of Recent Articles Publisher Pubmed



Ayati A¹ ; Sarraf S¹ ; Asl Fallah S² ; Bagheri J¹ ; Ahmadi Tafti H^{1, 3} ; Same K¹ ; Hosseini K¹
Source: Journal of Cardiac Surgery Published:2022

Abstract

Introduction: Acute-type aortic dissection (AD) during pregnancy is considered a rare and potentially fatal complication for both mother and fetus. Although the definite treatment for an acute-type AD is considered to be open-heart surgery, the decision to perform such a surgery during pregnancy requires a multidisciplinary approach and carries significant risks. Methods: In the present review of the literature, we have discussed various challenges in the management of acute-type AD during pregnancy, including therapeutic approaches, choosing the preferred imaging modalities, surgical techniques, and medication challenges. We have also reported an 8-week pregnant woman with Marfan syndrome who presented with chest pain and was diagnosed with acute AD. Results: The patient underwent a Bentall operation and was discharged in good condition with her fetus alive. The medical team's various decisions during preoperative, operative, and postoperative treatments were discussed. Conclusions: Type A AD is considered infrequent in the second and third trimester of pregnancy and rare in the first trimester. Performing a CMR study without contrast in stable patients can help evaluate the extension of the flap. Urgent surgery in the hands of a skilled surgeon may prove lifesaving for the mother while maximizing the likelihood of preserving the fetus. © 2022 Wiley Periodicals LLC.