Emergency repair of incidentally diagnosed ascending aortic aneurysm immediately after Caesarean section

A 36-yr-old pregnant woman with a history of hypertension presented at term for elective Caesarean section because of breech position. At preoperative examination, a diastolic murmur was found and transoesophageal echocardiog raphy (TOE) revealed a large, 8.1-cm diameter ascending aortic aneurysm wit h severe aortic regurgitation and moderate pericardial effusion. Surgical r epair was not considered to be urgently required. The patient was delivered electively by Caesarean section under epidural anaesthesia using invasive arterial pressure monitoring. TOE performed 6 h post-partum showed progress ing pericardial effusion, for which emergency replacement of the aortic val ve and ascending aorta were indicated. The epidural catheter was removed 4 h before starting the cardiopulmonary bypass procedure. Arterial pressure w as controlled by a titrated infusion of esmolol and clonidine. To improve u terine tone, the patient received an i.v. infusion of oxytocin throughout s urgery. After implantation of an aortic composite graft and weaning from ca rdiopulmonary bypass, the patient was transferred to the intensive care uni t. Awake and receptive to neurological evaluation, her trachea was extubate d 4 h after surgery. Mother and baby made an uneventful recovery.