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. 2021 Jan 1;6(1):58-66.
doi: 10.1001/jamacardio.2020.4876.

Clinical Features and Outcomes of Pregnancy-Related Acute Aortic Dissection

Alan C Braverman  1 , Eric Mittauer  2 , Kevin M Harris  3 , Arturo Evangelista  4 , Reed E Pyeritz  5 , Derek Brinster  6 , Lori Conklin  7 , Toru Suzuki  8 , Christina Fanola  9 , Maral Ouzounian  10 , Edward Chen  11 , Truls Myrmel  12 , Raffi Bekeredjian  13 , Stuart Hutchison  14 , Joseph Coselli  15 , Dan Gilon  16 , Patrick O'Gara  17   18 , Melinda Davis  19 , Eric Isselbacher  20 , Kim Eagle  19
Affiliations

Clinical Features and Outcomes of Pregnancy-Related Acute Aortic Dissection

Alan C Braverman et al. JAMA Cardiol. .

Abstract

Importance: Women with aortopathy conditions are at risk for pregnancy-related aortic dissection, and these conditions may not be recognized until after the aortic dissection occurs.

Objective: To examine the clinical characteristics, imaging features, and outcomes in women with pregnancy-related acute aortic dissection.

Design, setting, and participants: A cohort study, comprising data from the International Registry of Acute Aortic Dissection (IRAD) (February 1, 1998, to February 28, 2018). The multicenter referral center study included 29 women with aortic dissection during pregnancy or less than 12 weeks post partum in IRAD from 1998 to 2018.

Main outcomes and measures: Clinical features of pregnancy-related aortic dissection to be studied included underlying aortopathy, aortic size, type of aortic dissection, timing of dissection, hypertension, and previous aortic surgery.

Results: A total of 29 women (mean [SD] age, 32 [6] years) had pregnancy-related aortic dissection, representing 0.3% of all aortic dissections and 1% of aortic dissection in women in the IRAD. Among women younger than 35 years, aortic dissection was related to pregnancy in 20 of 105 women (19%). Thirteen women (45%) had type A aortic dissection, and 16 women (55%) had type B. Aortic dissection onset was known in 27 women (93%): 15 during pregnancy, 4 in the first trimester, and 11 in the third trimester; 12 were post partum, occurring a mean (SD) of 12.5 (14) days post partum. At type A aortic dissection diagnosis, the mean (SD) aortic diameters were sinus of Valsalva, 54.5 (5) mm and ascending aorta, 54.7 (6) mm. At type B aortic dissection diagnosis, the mean (SD) descending aortic diameter was 32.5 (5) mm. Twenty women (69%) had an aortopathy condition or a positive family history: 13 women (65%) with Marfan syndrome, 2 women (10%) with Loeys-Dietz syndrome, 2 women (10%) with bicuspid aortic valves, 2 women (10%) with a family history of aortic disease, and 1 woman (5%) with familial thoracic aortic aneurysm. Aortopathy was not recognized until after aortic dissection in 47% of the women. Twenty-eight women (97%) survived aortic dissection hospitalization.

Conclusions and relevance: Aortic dissection complicating pregnancy is rare. Most pregnancy-related aortic dissection is due to an aortopathy often not diagnosed until after aortic dissection. In this study, type A aortic dissections were associated with a dilated aorta, and type B aortic dissections often were not. Recognition of underlying conditions and risks for aortic dissection may improve management of pregnancy in women with aortopathy.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Brinster reported receiving personal fees from Terumo Aortic and personal fees from Cook Aortic outside the submitted work. Dr Ouzounian reported receiving personal fees from Medtronic Inc outside the submitted work. Dr Coselli reported receiving personal fees and other from Medtronic, personal fees and other from W. L. Gore, grants, personal fees, and other from Terumo Aortic, and other from Abbott Laboratories, Edwards, and Cytosorbents outside the submitted work. Dr Eagle reported receiving grants from W. L. Gore, Medtronic, and Terumo outside the submitted work. The International Registry of Acute Aortic Dissection (IRAD) study was supported by unrestricted grants from W. L. Gore, the Ann and Bob Aikens Aortic Fund, The Tom Varbedian Fund for Aortic Research, and grants from numerous participating IRAD aortic centers of excellence. No other disclosures were reported.

Figures

Figure.
Figure.. Aortopathy Diagnosis in Women With Pregnancy-Related Aortic Dissection
AA indicates aortic aneurysm; nsHTAD, nonsyndromic heritable thoracic aortic disease.
See this image and copyright information in PMC

Comment in

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