Pregnancy-related chronic type A aortic dissection highlights the importance of thorough prenatal maternal examination

Abstract

Background: Aortic dissection occurs rarely during pregnancy but carries a significantly high vital risk for both the mother and the fetus. Early diagnosis and treatment are critical for a successful outcome.

Case presentation: A 32-year-old pregnant woman at 31 weeks of gestation began experiencing shortness of breath, chest pain, and palpitations, which were attributed to an anxiety disorder she had been previously diagnosed with. The symptoms continued to worsen following the delivery when a chest computed tomography investigation revealed signs of chronic type A aortic dissection and an 80 mm post-dissection aneurysm of the ascending aorta. Aortic repair via composite aortic root replacement surgery (Bentall procedure) and partial aortic arch replacement was performed. The patient's postoperative evolution was notable for a series of complications.

Conclusions: Our report highlights the importance of thorough maternal examination during pregnancy. The high mortality rates associated with aortic dissection occurring in pregnant women and the possibility of missed intervention due to atypical clinical presentation warrant the need for standardized international protocols aimed at the prevention and timely diagnosis of prenatal aortic disease.

Keywords: Aortic dissection; Disease prevention; Pregnancy.

Fig. 1

Preoperative CT angiography axial (A) and parasagittal (B) views depicting the intraluminal intimal flaps (marked with an asterisk) and the significant size of the post-dissection aneurysm of the ascending aorta

Fig. 2

Intraoperative view of the enlarged aortic root. The intimal flaps were clearly visible upon the opening of the aorta

Fig. 3

CT angiogram showing a massive right-sided thoracic hematoma that was dislodging the mediastinum. The effusion was compressing the pulmonary arteries and the superior vena cava