Acute Type A Aortic Dissection in a 36-Week Pregnant Patient

Aortic dissection is a relatively rare yet often fatal condition. Early recognition and treatment are crucial for survival. While the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, and a family history of aortic dissection are also at an increased risk for developing this condition. A review of the literature revealed a paucity of published cases describing the successful, emergent repair of acute type A aortic dissections in third- trimester gravid patients. We present the case of the successful diagnosis and surgical repair of a 41-year-old female who presented to the emergency department with an acute type A aortic dissection at 36 weeks of gestation. 1. Introduction Aortic dissection is a rare complication of pregnancy with significant morbidity and mortality for both the mother and infant. In the general population, aortic dissection has an estimated incidence of 2.9 per 100,000 person years [1]. In pregnancy, acute type A aortic dissection has an overall incidence of 0.4 cases per 100,000 person years [2]. Common risk factors for developing aortic dissection include hypertension, collagen disorders including Marfan/Ehlers-Danlos syndromes, bicuspid aortic valve, positive family history, trauma, and cocaine use [3–7]. Mechanisms leading to aortic dissection involve a weakening of the layers of the aorta allowing blood to enter the media and separate the intimal and adventitial layers creating a false lumen. Acute aortic dissection during the third trimester of pregnancy has been attributed to hemodynamic alterations that occur in late pregnancy. These changes include increased total circulatory volume, increased systemic blood pressure, and structural changes in the aortic wall secondary to the hormonal effects of estrogen and progesterone [4]. A high index of suspicion by the emergency physician in addition to successful coordination of care between the emergency physician, obstetrician, and cardiothoracic/vascular surgeon is necessary for a successful outcome. 2. Case Report A previously healthy 41-year-old G1P0 female presented to the emergency department during the 36th week of pregnancy with a sudden onset of severe midsternal chest pain radiating to her back. The pain began roughly 30 minutes prior to her presentation to the ED and occurred as she was getting out of the swimming pool. She described the pain as continuous, 10/10 in severity, worsened with movement and breathing, and relieved by