Chest Pain Syndromes in Pregnancy

Surgical treatment of acute aortic dissection Stanford type A in the third trimester of pregnancy: A case report

Background

Aortic dissection is rare in pregnancy, but it is often life-threatening. Thus, early diagnosis and optimal treatment are crucial. In addition, regular multidisciplinary care plays an important role in improving the therapeutic outcome.

Case

A 31-year-old pregnant woman (gravida 2, para 1, abortus 0) was transferred to our centre at 34 weeks of gestation with onset of dyspnoea and serious chest pain radiating to her back. Ultrasonography unexpectedly revealed a dilation of the aortic root with a sign of dissection. Computed tomography confirmed a type A aortic dissection based on the Stanford classification. She was successfully treated by caesarean section prior to open repair of acute type A dissection and received multidisciplinary care. The patient was discharged on the 16th postoperative day, and the baby is still alive without adverse events.

Conclusion

Aortic dissection in pregnancy is relatively rare, but physicians should be on high alert for the condition when a pregnant woman has chest pain. Early diagnosis and adequate treatment in addition to regular multidisciplinary care are crucial to achieve favourable results.

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Acute aortic dissection is a life-threatening condition that requires urgent assessment and therapy.

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Aortic dissection in pregnancy is rare but can be fatal to the mother and to the fetus.

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Multidisciplinary care is required to achieve a favourable outcome.

Pathology of atherosclerotic coronary artery disease in the young Indian population

Atherosclerotic coronary artery disease (CAD) is of great concern in young adults because of its potential to cause great incapacitation. This arena of cardiology has gained importance in South Asian countries, particularly India due to increased prevalence that is related to traditional risk factors, altered life styles and inherent risk factors. In this study, we sought to evaluate, at autopsy, the pathology of atherosclerotic CAD in young patients with ischemic heart disease (IHD). A 10-year retrospective autopsy-based study was carried out in a large tertiary-care centre and patients aged ≤45 years with IHD were selected. Out of 545 autopsied cases of IHD, 95 patients (17.4%) were young. Among these 95 patients, 84 (88.4%) had IHD related to atherosclerotic CAD; the youngest patient was 18 years old. Predictably there was sole involvement of left anterior descending artery and the presence of fibrous plaques. Irrespective of the plaque morphology, the commonest complication was thrombosis produced by plaque erosion seen in 36.9% of patients. Acute coronary insufficiency was noted in 52 patients (61.9%), while healed infarctions were surprisingly noted in 28 patients (33.3%). Screening for IHD in the young population may help to improve prognosis by detecting subclinical disease, although more studies are necessary to establish reference limits for this young population. Additional research must also focus on treatment concerns that are specific to young patients.

Pneumothorax: A Rare Entity During Pregnancy

Pneumothorax is a rarely seen condition during pregnancy, when changes in the respiratory physiology can sensitize the mother and fetus to the signs of hypoxia. Symptoms of pneumothorax, such as dyspnea, tachypnea, and chest pain, can also be attributed to pregnancy and complications with pregnancy and this can lead to misdiagnoses. The limitations in the use of diagnostic tests, such as chest X-ray and computed tomography, make treatment more difficult. Here, we report of two cases admitted to our hospital due to spontaneous pneumothorax during pregnancy. The diagnosis of pneumothorax was made based on a thorax ultrasonography in both patients, whereas a chest X-ray was used in the follow-up period, without the need for a thorax tomography. While one patient was treated via a tube thoracostomy, the other was treated via video-assisted thoracoscopic surgery.

Spontaneous coronary artery dissection in a parturient with Nail-Patella syndrome

Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndrome, occurring predominantly in women during and immediately after pregnancy; it carries a mortality rate of greater than 50%. While the exact etiology is unknown, possible contributing factors include pregnancy-related hormonal, connective tissue and hemodynamic changes. We present a case of a 35-year-old multigravid woman with Nail-Patella syndrome who developed an acute myocardial infarction secondary to spontaneous coronary artery dissection during labor which was not diagnosed until after delivery. We hypothesize that abnormal collagen fiber formation found in Nail-Patella syndrome may have put her at an increased risk of coronary dissection and myocardial infarction. Regardless of etiology, a delay in diagnosis of myocardial ischemia can lead to significant morbidity and mortality. In light of the increasing burden of cardiac disease in the obstetric population, clinicians should remain vigilant for signs of myocardial infarction and prepare for definitive diagnosis and treatment.

Pregnancy-associated myocardial infarction : case report and review of the literature

Acute myocardial infarction (AMI) is a rare, but possibly catastrophic event during pregnancy, delivery, or puerperium, leading to a high mortality rate. It has different pathogenic mechanisms, such as atherosclerosis, vasospasm, thrombosis, and coronary dissection. Although MI has been reported in pregnant women at all stages of pregnancy and postpartum, it occurs more commonly in the third trimester. Pregnancy-associated MI most commonly involves the anterior wall. Pregnancy itself is an independent risk factor for MI, conferring a fourfold higher risk than that of nonpregnant women matched for age. We report the case of a 27-year-old primigravida at 30 weeks' gestation presenting with anterior MI, secondary to severe stenosis of the left anterior descending coronary artery, treated with emergency percutaneous coronary intervention.

Pregnancy outcomes in women with mitral valve prolapse and mitral valve regurgitation

PURPOSE

To examine pregnancy and perinatal outcomes in patients with mitral valve disorders [mitral valve prolapse and/or mitral regurgitation; mitral valve disorders (MVD)].

METHODS

A retrospective comparative study was conducted comparing all singleton deliveries, during the years 1988-2010, of women with and without known MVD. Women lacking prenatal care were excluded. Stratified analysis using logistic regression was performed to control for confounds.

RESULTS

Out of 233,194 singleton deliveries that occurred during the study period, 390 deliveries occurred in women with MVD. Using a multivariate analysis, advanced maternal age (OR = 1.06; 95 % CI 1.05-1.08; P < 0.001), recurrent abortions (OR = 1.62; 95 % CI 1.15-2.28; P = 0.005), hypertensive disorders (OR = 1.62; 95 % CI 1.17-2.26; P = 0.004) and Jewish ethnicity (OR = 2.21; 95 % CI 1.76-2.79; P < 0.001) were found to be significantly associated with MVD. Since cesarean sections (CS) were significantly higher in deliveries of patients with MVD (17.9 vs. 14 %; P = 0.025), another multivariate analysis was constructed, with CS as the outcome variable. MVD was not found to be an independent risk factor for CS (OR = 1.05; 95 % CI 0.79-1.37; P = 0.74).

CONCLUSIONS

MVD associated with advanced maternal age, recurrent abortions, Jewish ethnicity and hypertensive disorders were not found to be an independent risk factor for CS.