Obstet Gynecol Sci.  2016 Sep;59(5):403-406. 10.5468/ogs.2016.59.5.403.

Aortic dissection accompanied by preeclampsia in a postpartum young woman

• Park JW
• Kim SM
• Yu GB
• Kang YD

• KMID: 2391692
• DOI: http://doi.org/10.5468/ogs.2016.59.5.403

Abstract

Aortic dissection is very rare in obstetrics, but it is a fatal disease. A 37-weeks primigravida woman with dyspnea and pitting edema presented to our emergency room. The patient was diagnosed with preeclampsia and underwent an emergency cesarean section under spinal anesthesia. The patient complained of severe dyspnea after the cesarean section, and the chest computed tomography scan was done. With the finding of aortic dissection, cardiopulmonary arrest occurred 5 hours after the cesarean section, and the patient died without reaction to cardio-pulmonary resuscitation. If a patient with preeclampsia complains of severe dyspnea or chest pain, aortic dissection needs to be suspected and a diagnosis should not be delayed.

Keyword

Aortic dissection; Pre-eclampsia; Pregnancy

MeSH Terms

Anesthesia, Spinal
Cardiopulmonary Resuscitation
Cesarean Section
Chest Pain
Diagnosis
Dyspnea
Edema
Emergencies
Emergency Service, Hospital
Female
Heart Arrest
Humans
Obstetrics
Postpartum Period*
Pre-Eclampsia*
Pregnancy
Thorax

Figure

• 

  Fig. 1 (A) Preoperative anteroposterior chest X-ray showing increased opacity in both lower lung zone reveals bilateral pleural effusion. (B) Postoperative anteroposterior chest X-ray shows mediastinal widening with a large right pleural effusion.

• 

  Fig. 2 (A) An axial image of computed tomographic angiography of the thorax demonstrates a dissection of the descending thoracic aorta with the flap (arrow). (B) A coronal image of computed tomographic angiography of the thorax shows massive bilateral hemothorax and a ruptured dissection of the descending thoracic aorta (arrow head) between the T3 and T7 with saccular outpouching (arrow). It is classified Stanford type B or DeBakey type III dissection.

Reference

1. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000; 283:897–903.

2. Ray P, Murphy GJ, Shutt LE. Recognition and management of maternal cardiac disease in pregnancy. Br J Anaesth. 2004; 93:428–439.

3. Meszaros I, Morocz J, Szlavi J, Schmidt J, Tornoci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000; 117:1271–1278.

4. Bourland MD. Aortic dissection. In : Rosen P, Barkin R, editors. Emergency medicine. 4th ed. St. Louis (MO): Mosby;1998. p. 1819–1825.

5. Konishi Y, Tatsuta N, Kumada K, Minami K, Matsuda K, Yamasato A, et al. Dissecting aneurysm during pregnancy and the puerperium. Jpn Circ J. 1980; 44:726–733.

6. Parmley LF, Mattingly TW, Manion WC, Jahnke EJ Jr. Nonpenetrating traumatic injury of the aorta. Circulation. 1958; 17:1086–1101.

7. Anderson RA, Fineron PW. Aortic dissection in pregnancy: importance of pregnancy-induced changes in the vessel wall and bicuspid aortic valve in pathogenesis. Br J Obstet Gynaecol. 1994; 101:1085–1088.

8. Babatasi G, Massetti M, Bhoyroo S, Khayat A. Pregnancy with aortic dissection in Ehler-Danlos syndrome. Staged replacement of the total aorta (10-year follow-up). Eur J Cardiothorac Surg. 1997; 12:671–674.

9. Oskoui R, Lindsay J Jr. Aortic dissection in women <40 years of age and the unimportance of pregnancy. Am J Cardiol. 1994; 73:821–823.

10. Pedowitz P, Perell A. Aneurysms complicated by pregnancy. I. Aneurysms of the aorta and its major branches. Am J Obstet Gynecol. 1957; 73:720–735.

11. Barrett JM, Van Hooydonk JE, Boehm FH. Pregnancy-related rupture of arterial aneurysms. Obstet Gynecol Surv. 1982; 37:557–566.

12. Pumphrey CW, Fay T, Weir I. Aortic dissection during pregnancy. Br Heart J. 1986; 55:106–108.

13. Snir E, Levinsky L, Salomon J, Findler M, Levy MJ, Vidne BA. Dissecting aortic aneurysm in pregnant women without Marfan disease. Surg Gynecol Obstet. 1988; 167:463–465.

14. Zeebregts CJ, Schepens MA, Hameeteman TM, Morshuis WJ, de la Riviere AB. Acute aortic dissection complicating pregnancy. Ann Thorac Surg. 1997; 64:1345–1348.

15. Huang J, Liu H, Ding YL. Two cases of acute aortic dissection following preeclampsia in non-Marfan patients. Chin Med J (Engl). 2012; 125:2073–2075.