Abstract：Objective This study explores the diagnosis and treatment of late pregnancy-associated acute Stanford type A aortic dissection to improve the maternal and fetal outcomes. Methods A retrospective search of the cardiothoracic surgical database was conducted at the Affiliated Drum Tower Hospital of Nanjing University Medical School from May 2016 to November 2021 identified five pregnant women with type A dissection. The age of the patients ranged from 25 years old to 37 years old (median 31.7 years old) with gestational weeks of 31 to 37 weeks (median 35.3 weeks) upon diagnosis. One primipara and five multiparas were recorded. Transthoracic echocardiography showed that the degree of aortic regurgitation was mild in one case, moderate in two cases, and severe in three cases. The diameter of the aortic root was 40 mm to 60 mm, with an average of 47.7 mm. One case showed combined Marfon syndrome, one case showed preoperative combined cerebral infarction, and three cases showed gestational hypertension. The surgical plan was developed by considering the gestational week and the degree of entrapment. The observation indexes were cardiopulmonary bypass time, aortic blocking time,circulatory arrest time, time of postoperative tracheal extubation, ICU stay time, complications, neonatal weight, Apgar score at 1 min and 5 min, and others. Regular postoperative follow-ups for reoperation and survival were performed. Results All patients underwent Cesarean section first, and then, surgical aortic repair was performed. The interval was 0 h to 12 h (mean 5.7 h) between the two operations. Bentall + Sun's surgery was performed in two cases (one case with coronary artery bypass grafting). Ascending aorta replacement + Sun's surgery was performed in two cases (one case with brachiocephalic trunk stent placement). Bentall + partial arch replacement + proximal brachiocephalic trunk replacement surgery was performed in one case. Ascending aorta replacement + arch fenestrated stent surgery was performed in one case. Cardiopulmonary bypass time was 167 min to 350 min (mean, 275 min). Aortic blocking time was 139 min to 264 min (mean, 212 min). Circulatory arrest time was 15 min to 40 min (mean, 31.7 min). The postoperative tracheal extubation time was 23 h to 101 h (mean, 45.5 h). ICU stay time was 4 days to 8 days (mean, 5.7 days). The mother and fetus survived after the operation, and there were no complications, such as secondary chest opening, tracheotomy, cardiac arrest, or poor organ perfusion. The six cases of newborns were as follows: two cases of full-term delivery and four cases of preterm delivery with mild asphyxia in four cases. Birth weight was 2 250 g to 3 355 g (mean, 2 697 g). Apgar score at 1 min was 4 scores to 9 scores (mean, 6 scores) and at 5 min was 8 scores to 10 scores (mean, 9 scores). Follow-up was performed from 1 month to 66 months. The surviving patients showed no end leak in the descending aorta stent, and the distal dissection remained stable. One patient died 8 months after surgery due to depression. All six infants developed and grew well. Conclusion According to gestational age and degree of entrapment, patients with Stanford type A aortic dissection in late pregnancy can have good maternal and infant outcomes after undergoing Cesarean section followed by aortic repair surgery.
陆利冲, 程永庆, 葛敏, 陈成, 王志刚, 王东进, 王哲芸, 叶家欣. 晚期妊娠合并急性Stanford A型主动脉夹层的诊疗分析[J]. 中华解剖与临床杂志, 2022, 27(9): 640-645.
Lu Lichong, Cheng Yongqing, Ge Min, Chen Cheng, Wang Zhigang, Wang Dongjin, Wang Zheyun, Ye Jiaxin. Surgical management of acute Stanford type A aortic dissection associated with late pregnancy. Chinese Journal of Anatomy and Clinics, 2022, 27(9): 640-645.
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