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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Cesarean section in a pregnant woman with acute type A aortic dissection and tamponade with subsequent cardiopulmonary bypass and repair

Abstract Number: T 71
Abstract Type: Case Report/Case Series

Katherine M Jacobs D.O.1 ; Phillip Rauk M.D.2

Introduction: Aortic dissection in pregnancy while rare, can lead to devastating outcomes for both the mother and fetus. In women under the age of 40, over 50% of type A aortic dissections occur in the obstetric population (Katz NM et al. Am J Cardiol 1984;54(6):699-701). The most common risk factors for aortic dissections during pregnancy include hypertension, Marfan syndrome, Turner syndrome and bicuspid aortic valve.

Case description: A 34 year old G4P0121 at 33+3 weeks gestation presented to her local labor and delivery with complaints of substernal chest pain and shortness of breath. She was initially treated for indigestion, however the pain continued. An EKG showed sinus tachycardia. Cardiac enzymes and a chest x-ray were normal. A transthoracic echo was performed which showed the aortic root dilated to 6.7cm with linear echodensity consistent with dissection and a moderate pericardial effusion. The patient was stabilized and transferred via life flight to our tertiary care facility.

Upon arrival her blood pressure was 120/80 and her heart rate was 120 beats per minute. She was rushed to the operating suite for emergent cesarean section and subsequent ascending aortic repair with valve replacement.

Under general anesthesia the cesarean section was uncomplicated. A liveborn female infant was delivered, weighing 2390 grams with Apgars of 4 and 9 at 1 and 5 minutes, respectively. Intraoperative transesophageal echocardiogram revealed an acute ascending aortic dissection with signs of cardiac tamponade and a bicuspid aortic valve. During the cesarean delivery access was obtained for cardiopulmonary bypass via the right axillary artery and left femoral vein. After median sternotomy, the pericardial sac was opened and a large amount of dark blood and clot was removed. The dissection flap started from the non-coronary and right coronary cusp near the annulus and extended to the distal ascending aorta, involving both the right and left coronary ostia. A 25mm mechanical valve with conduit was used for the repair. The cardiopulmonary bypass time was 3 hours, and she was able to come off of bypass without issue. She was discharged from the hospital on post-operative day 5.

Discussion: This case illustrates the importance of early diagnosis of acute dissections during pregnancy to avoid potential catastrophic outcomes for both mother and fetus.

SOAP 2013