Original Article
Pregnancy combined with acute Stanford type A aortic dissection: single center experience and literature review
Lu Shuyang, Yao Wangchao, Huang Ben, Lai Hao, Li Jun, Gu Jiawei, Sun Yongxin, Wang Chunsheng
Published 2021-01-25
Cite as Chin J Thorac Cardiovasc Surg, 2021, 37(1): 14-17. DOI: 10.3760/cma.j.cn112434-20191019-00366
Abstract
ObjectiveTo summarize the clinical characteristics and surgical treatment experience of pregnant women with acute Stanford type A aortic dissection.
MethodsFrom January 2005 to December 2018, a total of 12 patients with acute Stanford type A aortic dissection were treated in Zhongshan Hospital affiliated to Fudan University. Two patients died of sudden aortic dissection rupture during emergency CTA examination. The other 10 patients underwent surgical treatment, the age was 22-40 years[mean(30.7±5.8) years], the pregnancy was 15-39 weeks[mean(28.8±6.5) weeks], two cases in the second trimester of pregnancy, seven cases in the third trimester of pregnancy and one case in puerperium. Among them, seven cases were Marfan syndrome, one case was bicuspid aortic valve malformation, two cases were complicated with pregnancy hypertension.
ResultsOne case died during perioperative period and died of rupture of abdominal aortic dissection in twelfth day after operation. One fetus was diagnosed as stillborn before operation. Before December 2013, six patients underwent surgeries, the mean cardiopulmonary bypass time was(96.8±16.5)min, aortic occlusion time was(70.8±19.3)min, intensive care unit time was(3.4±2.3) days, ventilator-assisted mechanical ventilation time was(21.6±15.6)h. After January 2014, four patients underwent surgeries, the mean cardiopulmonary bypass time was(202.3±6.4)min, the aortic cross-blocking time was(137.5±10.3)min, circulatory arrest time was(27.3±8.8)min, intensive care unit time was(12.0±5.7) days, and the ventilator-assisted mechanical ventilation time was(40.3±24.4)h. The postoperative complications included tracheotomy in two cases, hemodialysis in one case, poor wound healing in one case. One patient who had been treated with Bentall was followed up to sixth year and died of progressive rupture of descending arch dissection. One patient was followed up to seventh year after Bentall surgery, redo Bentall and Sun’s procedure were performed because of artificial valve infection, and was discharged uneventful. No adverse cardiovascular events occurred in other patients.
ConclusionSurgical treatment should be actively considered in pregnancy complicated with acute Stanford type A aortic dissection. Multi-disciplinary team cooperation can effectively improve the safety and effect of operation.
Key words:
Aortic dissection; Pregnancy; Surgical procedures
Contributor Information
Lu Shuyang
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
Yao Wangchao
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
Huang Ben
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
Lai Hao
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
Li Jun
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
Gu Jiawei
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
Sun Yongxin
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
Wang Chunsheng
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
