Open repair of enlarging chronic type B aortic dissection in a pregnant woman.

P0231 

Abstract Submission 

Lucas Ribe (1), Yuki Ikeno (1), Rana Afifi (2), Akiko Tanaka (3), Alexander Mills (4), Anthony Estrera (3)

(1) McGovern Medical School at UTHealth, Houston, TX, (2) Memorial Hermann, Houston, TX, (3) Memorial Hermann Heart and Vascular Institute, Houston, TX, (4) University of Texas Health Science Center at Houston (UTHealth Houston), N/A

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Rana Afifi    -  Contact Me
Memorial Hermann

Akiko Tanaka    -  Contact Me
Memorial Hermann Heart and Vascular Institute

Alexander Mills    -  Contact Me
University of Texas Health Science Center at Houston (UTHealth Houston)

*Anthony Estrera    -  Contact Me
Memorial Hermann Heart and Vascular Institute

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Objective:

Acute and chronic type B aortic dissection during pregnancy is a challenging cardiovascular disease. The best management for these patients is still unclear, and usually specific for each scenario. Therefore, guidelines are still required for this uncommon clinical situation.

Methods:

We present an unusual case of a 26-year-old pregnant woman who initially presented with chest pain and an enlarging post-dissection descending thoracic aortic (DTA) aneurysm. A computed tomography angiography (CTA) revealed a type B aortic dissection starting just distal to the origin of the left subclavian artery (LSA), extending to the superior mesenteric artery (SMA) origin (Fig. 1A). The descending thoracic aorta measured 5 cm in diameter. A large fenestration was seen in the proximal descending thoracic aorta (DTA) and at the origin of the celiac axis (Fig. 1B and Fig. 3). Transthoracic echocardiogram (TTE) displayed a dissection flap in the proximal DTA, with a compressed true lumen (Fig. 2A).

Results:

Due to non-reactive fetal tracings, after close management in the intensive care unit, she underwent cesarean section at 28- weeks of gestation.
Four months after the delivery and she had a successful open repair of the post- dissection descending thoracic aneurysm. Resection and graft replacement (reversed elephant trunk) of the descending thoracic aortic aneurysm, using a 30- mm woven dacron tube graft via a left modified thoracoabdominal incision (through the 6th intercostal space) was performed. The patient was discharged home 7 days after the procedure.

Conclusions:

Our case highlights the importance of a multidisciplinary team, including obstetrics and maternal-fetal-medicine (MFM) consultants, cardiothoracic and vascular surgery, intensive care physicians, and pediatric cardiologists, for a successful outcome of complex cases of chronic type B aortic dissection in pregnant women.

Dissection