ISSN: 1305-385X
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Aortic Dissection In Pregnancy
Dr. Bülent ÖZDEMİRa
aKardiyoloji AD, Uludağ Üniversitesi Tıp Fakültesi, BURSA
Aortic dissection is a disease characterized by tear of aortic intima, hematoma formation and separation of the arterial wall. There is complaint of pain in anterior chest wall, back or abdomen. The disease is found two times more frequent in men then woman. It is usually seen at age of 50-70. In etiology, hypertension ranks first. In young woman aortic dissection is rare. However, in female cases with age of less than forty, half of the dissections are seen during pregnancy, particularly in the 3rd trimester and puerperal period.
In pregnant woman, aortic dissection carries high risk both for the mother and the baby. With the effects of hormones, dilatations in aorta, renal and the resistance vessels of placenta occur. While lying in supine position, there is a pressure of uterus on aorta. Dissection risk increases with increasing number of pregnancies. Ehlers-Danlos and Marfan syndrome are other encountered reasons. In pregnant woman with coarctation of the aorta, the aortic disease related to the coarctation and hypertension increases rate of aortic rupture and dissection. The diagnosis should be made via transeosophageal echocardiography and magnetic resonance imaging that do not posses radiation risk. However these two are not always easy to reach. Computed tomography is rather safe in the last phases of pregnancy and usually available in many hospitals. If aortic root is dilated in case of Marfan syndrome and bicuspid aortic disease, operation before pregnancy is advised. If aortic root is wider than 4 cm and dilates further, beta blocker therapy is advised. In risky patients, achievement of lung maturation of the fetus at 26th week is targeted. High risk patients should be followed in hospital at their 28- 32nd week pregnancies. Cesarean section with regional anesthesia is a convenient approach. Close follow-up and beta blocker therapy should continue for 3 months after delivery. Before 30th week of pregnancy aortic repair should be made leaving the fetus in uterus. During the operation the health of the fetus can be monitored via cardiotocography.Keywords: Pregnancy, aortic diseaseTurkiye Klinikleri J Int Med Sci 2005, 1(50):54-58
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