P231. Open Repair of Enlarging Chronic Type B Aortic Dissection in a Pregnant Woman.
McGovern Medical School at UTHealth
Houston, TX
United States - Contact Me
Avanced Aortic Surgery Fellow at Memorial Hermann Hospital, Houston.
I currently live in Houston, where I am completing a two- year Fellowship in advanced aortic surgery. I am greatly engaged in open surgery for aortic aneurysms and dissections, as well as in modern vascular surgery, with large interest in vascular innovations, latest technology in vascular and aortic endovascular surgery, and greatly interested in medical and academic education, as well as surgical simulation.
I previously joined La Fe University Hospital in 2014 as a junior physician in angiology and vascular surgery, within the department of vascular surgery.
Prior to La Fe, I was the first Spanish junior vascular surgeon to complete a senior clinical Fellowship in aortic surgery at St. Mary’s Hospital, Imperial College of London, during an 18- month period,
and one of the first Spanish surgeons to become an official fellow of the European board of vascular and endovascular surgery (FEBVS).
Prior to this experience, I completed my residency in vascular surgery at Gregorio Marañón University hospital in Madrid, during a five- year period.
During my tenure in Madrid, I helped the hospital with the medical and residents training program, and participated in several national and international simulation courses, workshops, and meetings.
I am a graduate of the University of Alcala in Madrid, where I majored my bachelor in medicine.
Description
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.
Authors
Lucas Ribe (1), Yuki Ikeno (1), Rana Afifi (2), Akiko Tanaka (3), Alexander Mills (4), Anthony Estrera (3)
Institutions
(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