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 ...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 38^th 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.展开更多
To the Editor:For patients with acute DeBakey type laortic dissection,ascending aortic or hemiarch replacement can reduce the surgical time and save lives in critical situations.However,residual distal dissection incr...To the Editor:For patients with acute DeBakey type laortic dissection,ascending aortic or hemiarch replacement can reduce the surgical time and save lives in critical situations.However,residual distal dissection increases the risk of dilatation,rupture,and death.[1] In contrast,total aortic arch replacement(TAR)with frozen elephant trunk(FET)implantation can minimize the need for re-intervention,[2] but may increase the risk of operative mortality,stroke,paraplegia,and other complications.Currently,the ques-tion of the optimal surgical strategy for acute DeBakey type I aortic dissection remains controversial owing to the scarcity of long-term follow-up data and the technical diversities among different institutions.展开更多
基金Supported by Beijing Major Science and Technology Projects from Beijing Municipal Science and Technology Commission,No.Z171100001017083National Science and Technology Support Program of China,No.2015BAI12B03Beijing Lab for Cardiovascular Precision Medicine,No.PXM2017_014226_000037
文摘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 38^th 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.
基金the Natural Science Foundation of China(No.81970393)the Beijing Major Science and Technology Projects from the Beijing Municipal Science and Technology Commission(No.Z191100006619093).
文摘To the Editor:For patients with acute DeBakey type laortic dissection,ascending aortic or hemiarch replacement can reduce the surgical time and save lives in critical situations.However,residual distal dissection increases the risk of dilatation,rupture,and death.[1] In contrast,total aortic arch replacement(TAR)with frozen elephant trunk(FET)implantation can minimize the need for re-intervention,[2] but may increase the risk of operative mortality,stroke,paraplegia,and other complications.Currently,the ques-tion of the optimal surgical strategy for acute DeBakey type I aortic dissection remains controversial owing to the scarcity of long-term follow-up data and the technical diversities among different institutions.
