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Case Reports
. 2021 Jul 16:32:e00342.
doi: 10.1016/j.crwh.2021.e00342. eCollection 2021 Oct.

Acute type B aortic dissection in a pregnant woman with undiagnosed Marfan syndrome: A case report and review of the literature

Yumiko Miyazaki  1 , Makoto Orisaka  1 , Masataka Kato  1 , Hiroshi Kawamura  1 , Tetsuji Kurokawa  1 , Yoshio Yoshida  1
Affiliations
Case Reports

Acute type B aortic dissection in a pregnant woman with undiagnosed Marfan syndrome: A case report and review of the literature

Yumiko Miyazaki et al. Case Rep Womens Health. .

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.

Keywords: AoD, Acute aortic dissection; CT, computed tomography; HR, heart rate; Marfan syndrome; Multidisciplinary team; Pregnancy; TTE, Transthoracic echocardiography; Type B aortic dissection; bpm, beats per minute.

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Figures

Fig. 1
Fig. 1
Computed tomography scan with 3D reconstruction showing aortic dissection starting at the arch (arrow)
Fig. 2
Fig. 2
Transthoracic echocardiography shows dilatation of the Valsalva sinus to 38 mm (arrowheads)
Fig. 3
Fig. 3
Contrast computed tomography after caesarean section (A) The aortic dissection begins just distal to the left subclavian artery and extends along the descending aorta (arrows). (B) The dissection extends along the abdominal aorta to the aortic bifurcation, reaching the right external iliac artery and the left common iliac artery (arrows). CIA, common iliac artery; EIA, external iliac artery. (C) The three arterial branches of the left lower limb (ATA, PA, and PTA) are poorly visualised (arrows) compared with those of the right limb. ATA, anterior tibial artery; PA, peroneal artery; PTA, posterior tibial artery. (D) The aortic dissection extends to the origin of the left renal artery. (E) Contrast perfusion in the left kidney was poorer than that in the right kidney.
See this image and copyright information in PMC

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