Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2843-2850
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2843
Successful repair of acute type A aortic dissection during pregnancy at 16th gestational week with maternal and fetal survival: A case report and review of the literature
Su-Wei Chen, Yong-Liang Zhong, Yi-Peng Ge, Zhi-Yu Qiao, Cheng-Nan Li, Jun-Ming Zhu, Li-Zhong Sun
Su-Wei Chen, Yong-Liang Zhong, Yi-Peng Ge, Zhi-Yu Qiao, Cheng-Nan Li, Jun-Ming Zhu, Li-Zhong Sun, Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Su-Wei Chen, Yong-Liang Zhong, Yi-Peng Ge, Zhi-Yu Qiao, Cheng-Nan Li, Jun-Ming Zhu, Li-Zhong Sun, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Su-Wei Chen, Yong-Liang Zhong, Yi-Peng Ge, Zhi-Yu Qiao, Cheng-Nan Li, Jun-Ming Zhu, Li-Zhong Sun, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Su-Wei Chen, Yong-Liang Zhong, Yi-Peng Ge, Zhi-Yu Qiao, Cheng-Nan Li, Jun-Ming Zhu, Li-Zhong Sun, Beijing Engineering Research Center of Vascular Prostheses, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Author contributions: Chen SW, Zhong YL, Ge YP, Qiao ZY, and Li CN reviewed the literature; Chen SW drafted the manuscript; Zhu JM and Sun LZ were responsible for revising the manuscript for important intellectual content; and all of the authors approved the final version to be published.
Supported by Beijing Major Science and Technology Projects from Beijing Municipal Science and Technology Commission, No. Z171100001017083; National Science and Technology Support Program of China, No. 2015BAI12B03; Beijing Lab for Cardiovascular Precision Medicine, No. PXM2017_014226_000037.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jun-Ming Zhu, MD, Chairman, Chief Doctor, Director, Professor, Surgeon, Professor and Doctoral Supervisor of Cardiac Surgery, Department of Cardiovascular Surgery, Beijing Anzhen Hospital, 2 Anzhen Road, Chaoyang District, Beijing 100029, China. anzhenzjm@126.com
Telephone: +86-10-64456588 Fax: +86-10-64456588
Received: March 22, 2019
Peer-review started: March 22, 2019
First decision: July 30, 2019
Revised: August 21, 2019
Accepted: August 25, 2019
Article in press: August 26, 2019
Published online: September 26, 2019
Processing time: 186 Days and 19.8 Hours
Abstract
BACKGROUND

Aortic dissection during pregnancy is a rare but life-threatening event for mothers and fetuses. It often occurs in the third trimester of pregnancy and the postpartum period. Most patients have connective tissue diseases such as Marfan syndrome. Thus, the successful repair of a sporadic aortic dissection with maternal and fetal survival in the early second trimester is extremely rare.

CASE SUMMARY

A 28-year-old woman without Marfan syndrome presented with chest pain at the 16th gestational week. Aortic computed tomographic angiography confirmed an acute type A aortic dissection (TAAD) with aortic arch and descending aorta involvement. Preoperative fetal ultrasound confirmed that the fetus was stable in the uterus. The patient underwent total arch replacement with a frozen elephant trunk using moderate hypothermic circulatory arrest with the fetus in situ. The patient recovered uneventfully and continued to be pregnant after discharge. At the 38th gestational week, she delivered a healthy female infant by cesarean section. After 2.5 years of follow-up, the patient is uneventful and the child’s development is normal.

CONCLUSION

A fetus in the second trimester may have a high possibility of survival and healthy growth after aortic arch surgery.

Keywords: Aortic dissection; Pregnancy; Cardiopulmonary bypass; Hypothermia circulatory arrest; Case report

Core tip: Aortic dissection during pregnancy is a rare but life-threatening event for mothers and fetuses. The successful repair of a sporadic aortic dissection with maternal and fetal survival in the early second trimester is exceedingly rare. This case highlights that a fetus in the second trimester may have a high possibility of survival and healthy growth after aortic arch surgery using hypothermic circulatory arrest.