ACUTE AORTIC DISSECTION COMPLICATING PREGNANCY

Background. Acute aortic dissection occurring during pregnancy represe nts a lethal risk to both the mother and fetus. Our purpose was to stu dy the prevalence, treatments, and outcome of this rare problem and to suggest therapeutic guidelines. Methods. During the past 12 years, 6 pregnant women were admitted with an acute aortic dissection. Four had a type A and 2 had a type B dissection (Stanford classification). cat ion). Results. Two of the 4 patients with a type A dissection underwen t a combined emergency operation consisting of first cesarean section and then ascending aortic repair. Cesarean section was carried out 5 d ays after the emergency procedure on the aorta in the third patient, a nd 16 weeks later in the fourth patient. All 4 fetuses were delivered alive. One fetus died 6 days later, but the other 3 are alive and well al long-term follow-up. Of the 2 patients with a type B dissection, 1 was operated on for celiac ischemia; the other was treated medically. In both cases the fetus died in utero. There were no maternal deaths in either group. Conclusions. Cesarean section with concomitant aortic repair is recommended for pregnant women with a type A dissection, de pending on the gestational age. The maternal hemodynamic status will d etermine the sequence of the two procedures. Medical treatment is advi sed for patients with a type B dissection, but surgical repair is indi cated if complications such as bleeding or malperfusion of major side branches occur. (C) 1997 by The Society of Thoracic Surgeons.