JACC. Case reports · 2025
Multidisciplinary Management of Heritable Aortopathy in Pregnancy Complicated by Postpartum Acute Type A Dissection.
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Sperry Alexandra E, Rajendran Aardra, Salna Michael, Klammer Catherine, Wang Grace J, Brown Chase R, Levine Lisa, Lewey Jennifer, Desai Nimesh D
Аннотация
CASE SUMMARY: A 33-year-old patient at 20 weeks of gestation presented with a dilated aortic root and abdominal aorta, and a diagnosis of Loeys-Dietz syndrome was made.
KEY QUESTIONS: What is the incidence of pregnancy-related aortic dissection in patients with heritable thoracic aortic disease (HTAD)? What are the key management principles for pregnant patients with HTAD?
OUTCOME: A shared plan was made by a multidisciplinary team of maternal fetal medicine, cardio-obstetrics, and cardiothoracic surgery, consisting of imaging surveillance, blood pressure control, scheduled cesarean delivery, and future elective aortic surgery. After an uncomplicated delivery, the patient experienced an acute type A dissection requiring staged total aortic replacement, including aortic root and arch replacement, thoracoabdominal aortic replacement, and endovascular aortic repair.
TAKE-HOME MESSAGES: Patients with HTAD are at an increased risk of pregnancy-related aortic dissection. Key management principles include multidisciplinary evaluation, imaging surveillance, blood pressure control, and delivery with cardiothoracic surgical backup.
KEY QUESTIONS: What is the incidence of pregnancy-related aortic dissection in patients with heritable thoracic aortic disease (HTAD)? What are the key management principles for pregnant patients with HTAD?
OUTCOME: A shared plan was made by a multidisciplinary team of maternal fetal medicine, cardio-obstetrics, and cardiothoracic surgery, consisting of imaging surveillance, blood pressure control, scheduled cesarean delivery, and future elective aortic surgery. After an uncomplicated delivery, the patient experienced an acute type A dissection requiring staged total aortic replacement, including aortic root and arch replacement, thoracoabdominal aortic replacement, and endovascular aortic repair.
TAKE-HOME MESSAGES: Patients with HTAD are at an increased risk of pregnancy-related aortic dissection. Key management principles include multidisciplinary evaluation, imaging surveillance, blood pressure control, and delivery with cardiothoracic surgical backup.