1
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Singh G, Trehan S, Singh D, Goswami K, Arora RS. Aortic Dissection Masquerading as Pneumonia: A Case Report of an Atypical Presentation. Cureus 2024; 16:e65930. [PMID: 39221396 PMCID: PMC11365092 DOI: 10.7759/cureus.65930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Aortic dissection is a critical and life-threatening condition that can present with atypical symptoms, often leading to misdiagnosis and delayed treatment. The report presents a case of a 65-year-old male who initially exhibited fever, right-sided chest pain, and a productive cough, resulting in an initial diagnosis of pneumonia. Despite empirical antibiotic therapy, his symptoms persisted, prompting further investigation. A computed tomography (CT) scan ultimately revealed a Type B aortic dissection. The patient was then transferred to a specialized tertiary care facility for successful endovascular intervention. This case underscores the importance of considering aortic dissection in patients presenting with persistent, atypical symptoms that do not respond to standard treatments, such as unexplained fever and chest pain. It highlights the crucial role of advanced imaging techniques, such as CT scans, in achieving an accurate and timely diagnosis. Clinicians must maintain a high index of suspicion and ensure prompt referral to specialized centers to improve patient outcomes in this potentially fatal condition.
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Affiliation(s)
- Gurjot Singh
- Internal Medicine, Saint John Hospital, Southern Illinois University, Springfield, USA
| | - Shubam Trehan
- Internal Medicine, Saint John Hospital, Southern Illinois University, Springfield, USA
| | - Didar Singh
- Hospital Medicine, Springfield Clinic, Springfield, USA
- Internal Medicine, Springfield Memorial Hospital, Southern Illinois University, Springfield, USA
- Internal Medicine, Saint John Hospital, Southern Illinois University, Springfield, USA
| | - Kanishka Goswami
- Internal Medicine, Saint John Hospital, Southern Illinois University, Springfield, USA
| | - Rajpreet S Arora
- Internal Medicine, Saint John Hospital, Southern Illinois University, Springfield, USA
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2
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Huang CM, Wang CH, Wang HC, Chuang YT, Sung SY, Liao CY. Delivery-First Strategy Followed by Endovascular Repair to Treat Pregnant Woman With Acute Complicated Type B Aortic Dissection. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241265270. [PMID: 39070919 PMCID: PMC11283656 DOI: 10.1177/11795476241265270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 06/10/2024] [Indexed: 07/30/2024]
Abstract
Objective Aortic dissection, a rare but serious condition, requires timely diagnosis and treatment. Case report A case report involving a 33-year-old female with Stanford type B aortic dissection at 32 + 3 weeks gestational age highlights the importance of being alert to the symptoms and signs of this condition, particularly in patients with hypertension or a history of connective tissue disorders. The case report suggests a delivery first strategy followed by TEVAR procedure as the preferred approach for managing aortic dissection in pregnancy. This approach can alleviate pressure on the aorta, reduce the risk of rupture, and provide time for stabilization and preparation for the TEVAR procedure. Conclusion The case report emphasizes the criticality of recognizing and treating aortic dissection in pregnant patients promptly, given its potential life-threatening impact on both mother and fetus.
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Affiliation(s)
- Chen Ming Huang
- Department of Cardiovascular Surgery, Mennonite Christian Hospital, Hualien, Taiwan
| | - Chen-Hua Wang
- Department of Anesthesiology, Mennonite Christian Hospital, Hualien, Taiwan
| | - Hao-Chin Wang
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Yi-Ting Chuang
- Department of Medical Education and Research, Mennonite Christian Hospital, Hualien, Taiwan
| | - Shu-Yi Sung
- Department of Obstetrics and Gynecology, Mennonite Christian Hospital, Hualien, Taiwan
| | - Chi-Yuan Liao
- Department of Obstetrics and Gynecology, Mennonite Christian Hospital, Hualien, Taiwan
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3
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Chauhan R, Balakrishnan I, Mishra K, Kumar V. Ruptured Aortic Aneurysm in Pregnancy, Anesthetic Management of Endovascular Procedure. Ann Card Anaesth 2024; 27:249-252. [PMID: 38963361 PMCID: PMC11315253 DOI: 10.4103/aca.aca_111_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 07/05/2024] Open
Abstract
ABSTRACT Advanced pregnancy is associated with a higher risk of complicated aortopathies owing to the physiologic changes in pregnancy. The diagnosis can be elusive due to its rare incidence. The optimal treatment strategy is chosen based on the clinical condition of the patient, gestational age, and the severity of the aortic disease. A healthy young primigravida presented with acute chest pain in the early second trimester, diagnosed as a thoracic aortic aneurysm that had ruptured causing hemothorax. She underwent emergency endovascular repair under general anesthesia. Aortic disease should always be ruled out early in acute chest pain in pregnancy. Expeditious and strategic management helps improve maternal and fetal outcomes.
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Affiliation(s)
- Richa Chauhan
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ira Balakrishnan
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Keshabanand Mishra
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Virendra Kumar
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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4
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Zhang L, Wei Y, Cheng L, Ren H. Acute mesenteric ischemia following acute type A aortic dissection during the postpartum period: A case report. Asian J Surg 2024:S1015-9584(24)00713-9. [PMID: 38670813 DOI: 10.1016/j.asjsur.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Affiliation(s)
- Linming Zhang
- Intensive Care Unit, Wuhan Asia General Hospital, WuHan, 430058, China
| | - Yangyan Wei
- Department of Cardiac Surgery, Wuhan Asia General Hospital, Wuhan, 430058, China
| | - Liqing Cheng
- Pharmacist of Traditional Chinese Medicine, Wuhan Asia General Hospital, Wuhan, 430058, China
| | - Haibo Ren
- Intensive Care Unit, Wuhan Asia Heart Hospital, Wuhan, 430022, China.
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5
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Ceuppens AS, De Meester P, Van De Bruaene A, Voigt JU, Van Calsteren K, Budts W, Troost E. Aorta pathology and pregnancy-related risks in adult congenital cardiac disease: does the aorta dilate during pregnancy? Obstet Med 2024; 17:41-46. [PMID: 38660320 PMCID: PMC11037198 DOI: 10.1177/1753495x231156851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/20/2023] [Indexed: 04/26/2024] Open
Abstract
Background Aortic dilatation and pregnancy are major concerns in women with aortopathy (AOP). This single-centre retrospective analysis focuses on the evolution of aortic diameters during and after pregnancy in women with Marfan syndrome (MS), Turner syndrome (TS) and bicuspid aortic valve (BAV) aortopathy. Methods and results Thirty-eight women who had one or more single pregnancies were included. The ascending aorta was measured during pregnancy and postpartum. During pregnancy, a significant increase of diameters of the sinus aortae (median 1.4 mm; [-1.3; 3.8]) and ascending aorta (median 2.1 mm; [0.0; 4.0]) was noted. Systemic hypertension gives dilation of the aorta, but it did not influence the overall trajectory during pregnancy. Conclusion Significant aortic dilatation is noted during pregnancy in women with underlying AOP, even persisting in the long term. Pre-existing systemic hypertension is associated with larger aortic diameters prior to pregnancy. More research on a larger study population however is needed.
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Affiliation(s)
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | | | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Els Troost
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
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6
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Jackson NR. Ruptured Aortic Dissection in an Unrecognized, Late-Term Intrauterine Pregnancy. Am J Forensic Med Pathol 2024; 45:e11-e13. [PMID: 37788084 DOI: 10.1097/paf.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
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7
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Barroso D, Santos S, Tomás AS, Castro H, Pinheiro Vieira A. Aortic Dissection With Cardiac Tamponade in Pregnancy: A Challenging Clinical Scenario. Cureus 2023; 15:e44126. [PMID: 37750125 PMCID: PMC10518221 DOI: 10.7759/cureus.44126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Aortic dissection is the acute aortic syndrome with the highest mortality, and pregnancy and arterial hypertension are known risk factors. Its association with the perinatal period is a particularly unique and potentially devastating clinical catastrophe which is why the approach to a pregnant woman in cardiorespiratory arrest (CRA) should be multidisciplinary and early, with extraction of the fetus ideally within five minutes after the arrest. We present the case of a 39-year-old pregnant woman, who presented with a cardiorespiratory arrest in the context of an aortic dissection with cardiac tamponade and the need for an urgent perimortem cesarean section. Increasing knowledge and understanding among healthcare professionals has the potential to aid in the early detection and effective treatment of this challenging medical issue.
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Affiliation(s)
- Daniela Barroso
- Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Sérgio Santos
- ACES (Agrupamento de Centros de Saúde) Grande Porto III-Maia/Valongo, Family Medicine, Maia, PRT
| | - Ana Sofia Tomás
- Anesthesiology and Critical Care, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Heloísa Castro
- Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, PRT
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8
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Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene. Life (Basel) 2022; 12:life12101511. [DOI: 10.3390/life12101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. Acute AD survivors ultimately enter a chronic aortic disease course. Patients with chronic thoracic AD (CTAD) require lifelong surveillance and a proportion of them may present with symptoms and late complications demanding further surgical or endovascular treatment. However, the available data concerning the management of CTAD is sparse in the literature. The management of patients with CTAD is challenging as far as determining the best medical therapy and deciding on intervention are concerned. Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic AD. The diagnostic methods for imaging aortic diseases have been improved, while the data on new endovascular and surgical approaches has increased significantly. In this review, we summarize the current evidence in the diagnosis and management of CTAD and the latest recommendations for the surgical/endovascular aortic repair of CTAD.
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9
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Miyazaki Y, Orisaka M, Kato M, Kawamura H, Kurokawa T, Yoshida Y. Acute type B aortic dissection in a pregnant woman with undiagnosed Marfan syndrome: A case report and review of the literature. Case Rep Womens Health 2021; 32:e00342. [PMID: 34354931 PMCID: PMC8325095 DOI: 10.1016/j.crwh.2021.e00342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022] Open
Abstract
Aortic dissection during pregnancy is rare but can be life-threatening to both the mother and the foetus. Marfan syndrome is a major risk factor for acute aortic dissection during pregnancy. Here, we present the case of a woman who had not been diagnosed with Marfan syndrome prior to pregnancy and who developed acute type B dissection at 32 weeks of gestation. The maternal hemodynamic status was stable, and foetal well-being was ensured. However, under conservative treatment, the dissection extended to the descending aorta, reaching the bilateral iliac artery 2 days later. Due to foetal distress, preterm delivery was performed via caesarean section. The primary treatment of type B aortic dissection is conservative medical treatment, with the goals of hemodynamic stabilisation, minimising the extent of the dissection and decreasing the risk of rupture. However, type B aortic dissection, even the uncomplicated type, in pregnant women may require early and aggressive obstetric interventions to improve maternal and foetal prognoses.
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Affiliation(s)
- Yumiko Miyazaki
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Japan
| | - Makoto Orisaka
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Japan
| | - Masataka Kato
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Japan
| | - Hiroshi Kawamura
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Japan
| | - Tetsuji Kurokawa
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Japan
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10
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Marfan Syndrome Versus Bicuspid Aortic Valve Disease: Comparative Analysis of Obstetric Outcome and Pregnancy-Associated Immediate and Long-Term Aortic Complications. J Clin Med 2020; 9:jcm9041124. [PMID: 32326432 PMCID: PMC7230569 DOI: 10.3390/jcm9041124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 12/19/2022] Open
Abstract
Pregnancy poses a threat to women with aortopathy. Conclusive data on the obstetric and aortic outcome in this risk collective, especially when it comes to aortic complications in the long term, are still missing. This study offers a comparative analysis of pregnancy-associated outcome in 113 consecutive women with Marfan syndrome or bicuspid aortic valve disease, including 46 ever-pregnant and 37 never-pregnant women with Marfan syndrome, and 23 ever-pregnant and 7 never-pregnant females with bicuspid aortic valve disease. The overall obstetric outcome was comparable between ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease (p = 0.112). Pregnancy-associated aortic dissection occurred in two women with Marfan syndrome (3%) during a total of 62 completed pregnancies, whereas no single case of aortic event occurred in women with bicuspid aortic valve disease during a total of 36 completed pregnancies (p = 0.530). In the long-term follow-up, aortic dissection occurred in 21% of ever-pregnant women with Marfan syndrome, but in none of the women with bicuspid aortic valve disease (p = 0.022). Proximal aortic surgery was performed with similar frequency in ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease in the long term (p = 0.252). However, ever-pregnant women with Marfan syndrome were younger when surgery was performed (44 ± 9 vs. 59 ± 7 years; p = 0.041). In Marfan syndrome, long-term growth of the aorta was comparable between ever-pregnant and never-pregnant women. Pregnancy thus exhibited an increased immediate aortic risk only in women with Marfan syndrome, but not in women with bicuspid aortic valve disease. Previous pregnancy did not relate to an increased long-term risk of adverse aortic events in women with Marfan syndrome or with bicuspid aortic valve disease.
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11
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李 欣, 张 洪, 韩 凤, 于 长, 范 小, 范 瑞, 庄 建. [Surgical management of pregnancy-associated acute Stanford type A aortic dissection: analysis of 5 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1555-1558. [PMID: 29180341 PMCID: PMC6779635 DOI: 10.3969/j.issn.1673-4254.2017.11.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explore the diagnosis and treatment of pregnancy-associated acute Stanford type A aortic dissection to improve the maternal and fetal outcomes. METHODS We analyzed the perioperative data of 5 pregnant women with acute Stanford type A aortic dissection treated between June, 2009 and February, 2017. RESULTS The median age of the women was 30 years (range, 22-34 years) with gestational weeks of 23-38 weeks upon diagnosis. All the 5 patients received surgical interventions. Three patients underwent caesarean delivery and hysterectomy, and the fetuses survived after the surgery; 2 patients chose to continue pregnancy following the surgery, among whom one died due to postoperative complications and the other underwent termination of pregnancy. During follow-up, the surviving patients showed no endoleak in the descending aorta stent and the distal dissection remained stable. CONCLUSION The maternal and fetal outcomes of pregnancy-associated acute Stanford type A aortic dissection can be improved by multidisciplinary cooperation and optimization of the surgical approaches according to the time of pregnancy, fetal development and conditions of the aortic lesions.
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Affiliation(s)
- 欣 李
- 广东省心血管病研究所//广东省人民医院//广东省医学科学院 心外科,广东 广州 510080Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 洪宇 张
- 广东省心血管病研究所//广东省人民医院//广东省医学科学院 心外科,广东 广州 510080Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 凤珍 韩
- 广东省心血管病研究所//广东省人民医院//广东省医学科学院 产科,广东 广州 510080Department of obstetrics, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 长江 于
- 广东省心血管病研究所//广东省人民医院//广东省医学科学院 心外科,广东 广州 510080Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 小平 范
- 广东省心血管病研究所//广东省人民医院//广东省医学科学院 心外科,广东 广州 510080Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 瑞新 范
- 广东省心血管病研究所//广东省人民医院//广东省医学科学院 心外科,广东 广州 510080Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 建 庄
- 广东省心血管病研究所//广东省人民医院//广东省医学科学院 心外科,广东 广州 510080Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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12
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Goland S, Elkayam U. Pregnancy and Marfan syndrome. Ann Cardiothorac Surg 2017; 6:642-653. [PMID: 29270376 PMCID: PMC5721114 DOI: 10.21037/acs.2017.10.07] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/16/2017] [Indexed: 01/15/2023]
Abstract
Pregnancy in women with Marfan syndrome (MFS) presents challenges to the clinician and the patient due to the increased incidence of maternal complications and involvement of the fetus, and deserves special consideration. The leading cause of morbidity and mortality in MFS is aortic dissection. This article presents an extensive review of available clinical information and provides recommendations for the management of patients with MFS during pregnancy.
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Affiliation(s)
- Sorel Goland
- Heart Institute, Kaplan Medical Center, Rehovot, affiliated to Hebrew University, Jerusalem, Israel
| | - Uri Elkayam
- Department of Medicine, Division of Cardiovascular Disease, and Department of Obstetrics and Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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13
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Liu YY, Li HY, Jiang WJ, Guan XL, Wang XL, Liu O, Zhu JM, Sun LZ, Zhang HJ. Treatment of patients with aortic disease during pregnancy and after delivery. J Int Med Res 2017; 45:1359-1368. [PMID: 28587539 PMCID: PMC5625542 DOI: 10.1177/0300060517711088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study aimed to review treatment of patients with aortic disease during pregnancy and after delivery in Beijing Anzhen Hospital. Methods A retrospective study was conducted using data from 12 patients with aortic disease during pregnancy and after delivery in our institution from May 2005 to December 2014. Patients were provided different treatments based on the type of aortic disease and clinical characteristics. Results The mean age was 29.83 ± 4.17 years, mean height was 171.7 ± 8.22 cm, mean weight was 68.55 ± 10.62 kg, and mean body mass index was 23.18 ± 2.93 kg/m2. Two patients with Stanford type A aortic dissection died of renal failure after surgery. All of the other patients were discharged. Six foetuses survived. One patient continued her pregnancy after an aortic operation. The gestational age of the remaining five patients was less than 28 weeks at the time of the operation and all foetuses of these five patients died. Conclusions A suitable treatment strategy for aortic disease during pregnancy and after delivery should be chosen based on an individual’s comprehensive clinical condition. Foetal management should be chosen based on gestational age and severity of aortic disease.
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Affiliation(s)
- Yu-Yong Liu
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Hai-Yang Li
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Wen-Jian Jiang
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Xin-Liang Guan
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Xiao-Long Wang
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Ou Liu
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Jun-Ming Zhu
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Li-Zhong Sun
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Hong-Jia Zhang
- 1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,2 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,3 Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,4 Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,5 Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
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14
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Yuan SM. Cardiac myxoma in pregnancy: a comprehensive review. Braz J Cardiovasc Surg 2016; 30:386-94. [PMID: 26313731 PMCID: PMC4541787 DOI: 10.5935/1678-9741.20150012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/16/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Cardiac myxoma in pregnancy is rare and the clinical characteristics of this entity have been insufficiently elucidated. This article aims to describe the treatment options and the risk factors responsible for the maternal and feto-neonatal prognoses. METHODS A comprehensive search of the literature of cardiac myxoma in pregnancy was conducted and 44 articles with 51 patients were included in the present review. RESULTS Transthoracic echocardiography was the most common diagnostic tool for the diagnosis of cardiac myxoma during pregnancy. Cardiac myxoma resection was performed in 95.9% (47/49); while no surgical resection was performed in 4.1% (2/49) patients (P=0.000). More patients had an isolated cardiac myxoma resection in comparison to those with a concurrent or staged additional cardiac operation [87.2% (41/47) vs. 12.8% (6/47), P=0.000]. A voluntary termination of the pregnancy was done in 7 (13.7%) cases. In the remaining 31 (60.8%) pregnant patients, cesarean section was the most common delivery mode representing 61.3% and vaginal delivery was more common accounting for 19.4%. Cardiac surgery was performed in the first, second and third trimester in 5 (13.9%), 14 (38.9%) and 17 (47.2%) patients, respectively. No patients died. In the delivery group, 20 (76.9%) neonates were event-free survivals, 4 (15.4%) were complicated and 2 (7.7%) died. Neonatal prognoses did not differ between the delivery modes, treatment options, timing of cardiac surgery and sequence of cardiac myxoma resection in relation to delivery. CONCLUSION The diagnosis of cardiac myxoma in pregnancy is important. Surgical treatment of cardiac myxoma in the pregnant patients has brought about favorable maternal and feto-neonatal outcomes in the delivery group, which might be attributable to the shorter operation duration and non-emergency nature of the surgical intervention. Proper timing of cardiac surgery and improved cardiopulmonary bypass conditions may result in even better maternal and feto-neonatal survivals.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, CN
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15
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Chronic type B aortic dissection in a pregnant patient managed by simultaneous thoracic endovascular aortic repair and cesarean section in the hybrid operating room. J Vasc Surg Cases 2016; 2:25-27. [PMID: 31724638 PMCID: PMC6849965 DOI: 10.1016/j.jvsc.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 02/02/2016] [Indexed: 11/24/2022] Open
Abstract
We present the case of a 50-year-old gravida with a chronic Stanford type B aortic dissection with false lumen aneurysm and discuss a literature-based treatment strategy. She underwent oocyte donation in the United States and was seen in week 15 of gestation. We chose a strategy of "watchful waiting" at a constant aortic diameter of 52 mm on magnetic resonance imaging. In week 32 + 6 days, cesarean delivery was induced in a hybrid operating room with subsequent thoracic endovascular aortic repair to reduce the risk of early dilation and rupture during the nursing period. One year later, she cared for her healthy baby with stable aortic diameters.
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16
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Kim WH, Bae J, Choi SW, Lee JH, Kim CS, Cho HS, Lee SM. Stanford type A aortic dissection in a patient with Marfan syndrome during pregnancy: a case report. Korean J Anesthesiol 2016; 69:76-9. [PMID: 26885307 PMCID: PMC4754272 DOI: 10.4097/kjae.2016.69.1.76] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 12/21/2022] Open
Abstract
Aortic dissection during pregnancy is a devastating event for both the pregnant woman and the baby. We report a case of acute aortic dissection (Stanford type A) in a pregnant woman with Marfan syndrome at the 29th week of gestation. She underwent a cesarean section followed by an ascending aorta and total arch replacement with cardiopulmonary bypass, without a prior sternotomy. The hemodynamic parameters were kept stable during the cesarean section by using inotropes and vasopressors under transesophageal echocardiography monitoring. The newborn survived after endotracheal intubation and management in a neonatal intensive care unit.
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Affiliation(s)
- Won Ho Kim
- Department of Anesthesiolgy and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jisue Bae
- Department of Anesthesiolgy and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seung Won Choi
- Department of Anesthesiolgy and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiolgy and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Su Kim
- Department of Anesthesiolgy and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Sung Cho
- Department of Anesthesiolgy and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangmin M Lee
- Department of Anesthesiolgy and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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Gu X, Liu H, Li Y, Fei L, Shao D, Mao J, Nie S. Spontaneous type B aortic dissection in antepartum gemellary pregnancy and endovascular repair. Int J Clin Exp Med 2014; 7:4249-4252. [PMID: 25550939 PMCID: PMC4276197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/23/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND It has been found that 50% of all aortic dissections can be attributable to pregnancy in women younger than 45 years of age. An estimated 30% of cases are type B, with half occurring in the antepartum period. To date type B aortic dissection has rarely been reported in gemellary pregnancies. CASE A 24-year-old primigravida at 36 weeks of gemellary gestation presented symptoms of severe and persistent chest pain for 1 day, before suffering the acute type B aortic dissection. The primigravida was treated with immediate cesarean section and endovacular stent graft placement. CONCLUSION Aortic dissection is a rare complication of pregnancy, especially in gemellary pregnancies. Pregnancy is considered an independent risk factor for aortic dissection and endovascular repair may be an ideal option for the treatment of complicated type B aortic dissection during pregnancy, with reduced maternal and fetal mortality.
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Affiliation(s)
- Xudong Gu
- Department of Emergency Medicine, Nanjing Jinling HospitalJiangsu, China
| | - Hongmei Liu
- Department of Emergency Medicine, Nanjing Jinling HospitalJiangsu, China
| | - Yusheng Li
- Department of Emergency Medicine, Nanjing Jinling HospitalJiangsu, China
| | - Libo Fei
- Department of Emergency Medicine, Nanjing Jinling HospitalJiangsu, China
| | - Danbing Shao
- Department of Emergency Medicine, Nanjing Jinling HospitalJiangsu, China
| | - Jianhua Mao
- Department of The Medical Affairs, Nanjing Jinling HospitalJiangsu, China
| | - Shinan Nie
- Department of Emergency Medicine, Nanjing Jinling HospitalJiangsu, China
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18
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Yang Z, Yang S, Wang F, Wang C. Acute aortic dissection in pregnant women. Gen Thorac Cardiovasc Surg 2014; 64:283-5. [PMID: 25085319 DOI: 10.1007/s11748-014-0460-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/28/2014] [Indexed: 12/24/2022]
Abstract
Acute aortic dissection occurring during pregnancy represents a lethal risk to both the mother and fetus. Management of parturient with acute aortic dissection is complex. We report our experience of two pregnancies with type A acute aortic dissection. One patient is a 31-year-old pregnant woman (33rd gestational week) with a bicuspid aortic valve and the other is a 32-year-old pregnant woman (30th gestational week) with the Marfan syndrome. In both cases, a combined emergency operation consisting of Cesarean section, total hysterectomy prior to corrective surgery for aortic dissection was successfully performed within a relatively short period of time after the onset. Both patients' postoperative recovery was uneventful, and we achieved a favorable maternal and fetal outcome.
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Affiliation(s)
- Zhaohua Yang
- Department of Cardiothoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China.
| | - Shouguo Yang
- Department of Cardiothoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
| | - Fangshun Wang
- Department of Cardiothoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
| | - Chunsheng Wang
- Department of Cardiothoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
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