Giant Ascending Aortic Aneurysm Diagnosed During Labor.

BACKGROUND

Giant ascending aortic aneurysms (AscAAs; >10 cm) are exceptionally rare and may remain clinically silent until catastrophic complications occur. We report the incidental diagnosis of a giant AscAA during labor in a previously asymptomatic young woman.

CASE SUMMARY: A 20-year-old primigravid woman underwent emergency cesarean delivery for maternal hemodynamic and respiratory instability. Postpartum echocardiography (transthoracic echocardiography) revealed a 140-mm AscAA with severe aortic regurgitation and left ventricular dilatation; computed tomography angiography confirmed a maximum diameter of 125 mm. Three weeks later, she underwent a Bentall procedure. Femoral cannulation was established before sternotomy because of the aneurysm's proximity to the sternum. The aorta was safely cross-clamped proximal to the brachiocephalic trunk, avoiding circulatory arrest. Recovery was uneventful, and she has remained asymptomatic at the 4-month follow-up.

DISCUSSION: Giant AscAAs during pregnancy are extraordinarily uncommon and carry a high risk of rupture, dissection, and maternal mortality, requiring meticulous multidisciplinary planning.

TAKE-HOME MESSAGE: Early multimodality imaging and individualized surgical planning are essential for achieving favorable outcomes in this life-threatening condition.