CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 10, November 2012
AFRICA
e7
Case Report
Successful management of spontaneous aortic
dissection type B in the third trimester of pregnancy
YAVUZ SİMSEK, CENGİZ COLAK, ERCAN YİLMAZ, EBRU CELİK, NEVZAT ERDİL, ONDER CELİK
Abstract
Acute aortic dissection is a life-threatining disease that
requires immediate surgical intervention. Although aortic
dissection is a rare condition during pregnancy, it is of high
risk for both mother and foetus. Most cases of aortic dissec-
tion during pregnancy have certain risk factors, including
Marfan syndrome and congenital heart diseases. In this
study, we report on a case of acute aortic dissection devel-
oping spontaneously at 32 weeks of gestation. The patient
delivered a baby through cesarean section, and medical
management of the dissection was commenced. Both mother
and neonate survived and recovered well.
Keywords:
aortic diseases, pregnancy, hypertension, therapy
Submitted 28/3/12, accepted 3/9/12
Cardiovasc J Afr
2012;
23
:
e7–e9
DOI: 10.5830/CVJA-2012-063
Acute aortic dissections (AAD) affect predominantly male
patients, with a male-to-female ratio of 3:1.
1
In general,
pregnancy is considered a risk factor and nearly half of the cases
of dissection in young women occur during pregnancy, most
commonly in the third trimester.
2
The occurence of AAD during pregnancy can be life
threatening for both mother and foetus. Most reported cases are
associated with recognisable risk factors, including connective
tissue disease (e.g. Marfan’s syndrome), systemic hypertension
and congenital heart diseases (e.g. coarctation of the aorta and
bicuspid aortic valve).
3
The Stanford classification divides dissections into two types,
type A and B. Most reported cases of aortic dissection during
pregnancy are type A.
4
We report here on the diagnosis and management of a case
of AAD type B in the third trimester of pregnancy in a parous
woman without any identifiable risk factors. We discuss the topic
below, with a relevant literature review.
Case report
A 36-year-old gravidy 4, parity 3 patient at 32 weeks of gestation
was referred to our emergency clinic with the symptom of
excrutiating back pain, which had migrated to the left scapular
area, and had begun two hours earlier. This was accompanied by
nausea and minimal dyspnoea. No other symptoms were noted at
the time. The patient had not been taking any medications aside
from multivitamin pills. She was a non-smoker and had no prior
surgeries.
The patient’s vital signs were as follows: blood pressure
190/110
mmHg, pulse rate 90 beats/min with normal heart
sounds, axillary temperature was 37°C, and respiration rate 18
breaths/min. The lung sounds were clear during auscultation.
The results of other physical and neurological examinations were
unremarkable.
Peripheral pulse examination was normal in general, except
for the diagnosis of a weak pulse at the left femoral artery, and
loss of pulse at the more distal part of the left lower extremity.
Nevertheless, no evidence of ischaemia was noted in the affected
extremity.
A bimanual pelvic examination was unremarkable, with a
closed and unraped cervix. Obstetric ultrasonography showed a
single live foetus at 32 weeks of gestation with normal amniotic
fluid and placenta. The transvaginal sonography revealed normal
pelvic anatomy and minimal free fluid in the Douglas pouch.
Laboratory investigations showed the following
concentrations: alanine aminotransferase (ALT) 26 IU/l,
aspartate aminotransferase (AST) 28 IU/l, lactate dehydrogenase
(
LDH) 220 U/l, total bilirubin 0.2 mg/dl,
γ
-
glutamyl transferase
(
GGT) 10 IU/l, and alkaline phosphatase (ALP) 84 IU/l.
The prothrombin time (PT) was 11.5 s, with an international
normalised ratio (INR) of 0.8. The patient had normal serum
cardiac enzyme, glucose and lipase levels. Routine urine
examination was normal.
Chest radiography showed no significant cardiac or thoracic
findings. Echocardiography revealed normal left ventricular
functions, with normal anatomy of the valves. Neither pericardial
effusion nor any sign of aortic dissection was seen.
A presumptive diagnosis of aortic dissection was made and
the patient was informed. An emergency thoraco-abdominal
computed tomography (CT) scan was performed and an aortic
dissection beginning from the arc and extending to the infrarenal
segment of the descending aorta was diagnosed (type B) (Fig. 1).
The left common carotid artery and left subclavian artery were
anatomically normal.
Subsequently, sonography and Doppler scan of her lower
extremities were performed on the suspicion of peripheral
Department of Obstetrics and Gynaecology, Inonu
University Faculty of Medicine, Malatya, Turkey
YAVUZ SİMSEK, MD,
ERCAN YİLMAZ, MD
EBRU CELİK, MD
ONDER CELİK, MD
Department of Cardiovascular Surgery, Inonu University
Faculty of Medicine, Malatya, Turkey
CENGİZ COLAK, MD
NEVZAT ERDİL, MD
