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eComment: Acute type A aortic dissection at seven weeks of gestation in a Marfan patient

PSHC, King Fahad Medical City, PO Box 59046, Riyadh 11525, Kingdom of Saudi Arabia

Repair of an acute type A aortic dissection combined with an emergency cesarean section in a pregnant woman

I read with interest the case report by Shihata and colleagues [1] regarding combined cesarean section and repair of acute type A aortic dissection. Acute aortic dissection during pregnancy can be serious for both the mother and the fetus with a reported mortality of 1% per hour if untreated [2]. This time-related mortality imposes the need for high degree of suspicion and reliable diagnostic tools. The bedside transthoracic echocardiogram is used for initial diagnosis with sensitivity and specificity of 75% and 90%, respectively [2]. The close relation between the aortic dissection and pregnancy initiated Zeebregts and colleagues [3] to follow these cases over 12 years. They suggested a guideline for management according to the gestational age aiming to save two lives. Before 28 weeks gestation, aortic surgery with the fetus kept in the uterus is recommended. After 32 weeks gestation, primary cesarean section followed by aortic repair at the same setting is the management of choice as in the report of Shihata. We encountered recently a case of pregnant Marfan lady at seven weeks gestation who presented with acute type A aortic dissection. We performed an emergency Bentall operation under hypothermic circulatory arrest (circulatory arrest time was 11 min). The fetus survived the surgery and, at 35 weeks of gestation, the patient underwent an elective cesarean section and delivered a healthy baby. To our knowledge, our case is the first to report a favorable fetal outcome following surgical repair of acute dissection during the first trimester of pregnancy in a Marfan patient [4].

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1. Shihata M, Pretorius V, MacArthur R. Repair of an acute type A aortic dissection combined with an emergency cesarean section in a pregnant woman. Interact CardioVasc Thorac Surg 2008;7:938–940.[Abstract/Free Full Text]
2. Khan AK, Nair CK. Clinical, diagnostic and management perspectives of aortic dissection. Chest 2002;122:311–328.[CrossRef][Medline]
3. Zeebregts CJ, Schepens MA, Hameeteman TM, Morshuis WJ, De la Rivire AB. Acute aortic dissection complicating pregnancy. Ann Thorac Surg 1997;64:1345–1348.[Abstract/Free Full Text]
4. Shaker WH, Refaat AA, Hakami MA, Ibrahim MF. Acute type A aortic dissection at 7 weeks of gestation in a Marfan patient. J Cardiothorac Surg 2008. (in press).

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mohamed F. Ibrahim Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ibrahim, M. F. Articles by Refaat, A. A. Search for Related Content PubMed PubMed Citation Articles by Ibrahim, M. F. Articles by Refaat, A. A. Related Collections Related Article