Successful Repair of a Ruptured Acute Type B Aortic Dissection during Pregnancy

BACKGROUND:
Aortic dissection during pregnancy is rare. We present our experience with a case of an acute Type B aortic dissection occurring at 26 weeks gestation.
METHODS:
A literature review relating to aortic dissection and rupture during pregnancy was conducted and a case report of the same entity is described.
RESULTS:
Aortic dissection during pregnancy is uncommon and subsequent acute rupture is extremely rare. Aortic dissection can occur in patients both with and without connective tissue disorders such as Marfan’s syndrome. The usual management of Type B dissection during pregnancy is nonoperative and is directed at blood pressure control and close monitoring. We present the case of a 25 year old woman who presented at 26 weeks gestation with an acute Type B dissection (Figure one). She had no known diagnosis of connective tissue disorder or cardiovascular disease. She subsequently developed a rupture of her Type B dissection six days after presentation and underwent emergency cesarean delivery of a viable fetus followed by immediate repair of her thoracic aorta. She did well postoperatively and remains symptom free at three months and is able to fully care for her new baby girl. A follow up CT at three months demonstrates stable repair of her thoracic aorta with excellent visceral and extremity perfusion.
CONCLUSIONS:
Aortic dissection although rare does occur during pregnancy. This entity has been reported in patients both with and without risk factors for aortic dissection. If the clinical suspicion warrants radiologic studies should be performed despite the fetal risk of radiation exposure. The potential for fetal demise is a factor that must be addressed when intervention for acute complications of dissection, such as rupture or ischemia, is required. Emergency cesarean delivery followed by, or in conjunction with, immediate aortic intervention is the best treatment choice. A variety of options are available for addressing acute complications of Type B dissection including open and endovascular techniques.