Ode of Motherhood

P0229 

Abstract Submission 

Chery Lou Cabanero (1), Aquileo Rico (2)

(1) N/A, N/A, (2) N/A, Manila, Philippines

Chery Lou Cabanero    -  Contact Me
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Aquileo Rico    -  Contact Me
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Chery Lou Cabanero    -  Contact Me
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Objectives: The primary goal of this case series is to report two cases of aortic dissection during pregnancy, its sign of malperfusion during pregnancy and its outcomes after surgical treatment.

Methods: It is recognized that one of the most catastrophic conditions complicating pregnancies is aortic dissection. This case series will present two cases of aortic dissection during pregnancy and its outcomes.

Case A: A 36 year old Gravida 2 mother was admitted in the emergency department due to chest pain. On physical examination, the patient had loud systolic murmur at the second intercostal space parasternal line. Her CT Aortogram showed an intimal flap which originated at the aortic root extending at the infrarenal aorta. She had severe aortic regurgitation with good left ventricular function. With medications for tight blood pressure and heart rate control she was able to deliver a healthy baby girl at 37 weeks AOG via caesarean section. The patient underwent Modified Bentalls Procedure one month after her delivery with an uneventful postoperative course. Case B: A 31 year old hypertensive pregnant woman presented to the outpatient clinic with chest CT Scan of 7.32 x 9.40cm descending aorta dissection commencing at T5 down to T10, with a narrowed true lumen diameter supplying the ovarian artery distally. She was admitted for control of hypertension and heart rate. However, during the course of admission, her fetus developed intrauterine growth retardation. On the 28th week of gestation the patient underwent thoracic aortic endovascular repair. However, the fetus developed bradycardia and absence of fetal variability on fetal monitoring prompting delivery of a live preterm baby girl with APGAR 8,9 weighing 890 grams. The patient was discharged on the 8th postoperative day.

Results: The result of this case series is a good indication that aortic dissections during pregnancy can be managed conservatively. Fetal complications such as malperfusion in the fetal-maternal circulation may present with signs and symptoms culminating to intrauterine growth retardation.

Conclusion: In conclusion, aortic dissections during pregnancy can be managed medically during pregnancy. Tight control of heart rate, blood pressure and close monitoring of fetal growth should be strictly be monitored to avoid complications. We follow AHA and ESC guidelines for management of aortic dissections. Surgical repair through Modified Bentalls Procedure for type A dissections and endovascular repair for type B dissections produce favorable outcomes in terms of surgical management. We highly recommend that best efforts in completing the age of gestation or doing a procedure during the second trimester prevent adverse fetal outcomes. Lastly, malperfusion symptoms towards the developing baby maybe subtle but must be recognized with high degree of suspicion to prevent fetal loss in utero.

Dissection