Successful near-term pregnancy outcome after repair of a dissecting thoracic aortic aneurysm at 14 weeks gestation.
OBJECTIVE
We report the anesthetic management for a scheduled Cesarean section of a 29-yr-old female who previously had a repair of her dissecting thoracic aortic aneurysm during the 14th week of her pregnancy.


METHODS
A 29-yr-old female with a history of hypertension and previously diagnosed aortic dissection secondary to suspected Marfan's syndrome, presented to our institution for the first time after she became pregnant. A transesophageal echocardiogram revealed a dissecting aortic aneurysm greater than 8 cm in diameter beginning distal to the left subclavian artery and extending into the descending thoracic aorta. The patient was counseled in great detail about the risk of rupture with continuing pregnancy. She refused termination and chose elective repair of the aneurysm, with continuation of the pregnancy. Partial repair of the thoracic aneurysm was undertaken when the pregnancy was 13(5/7) weeks by ultrasound dates. She was subsequently maintained on labetolol and hydralazine for blood pressure control. A decision was made to proceed with a Cesarean section at 32 weeks. After placement of a radial artery catheter and two large peripheral iv catheters, she received a of 7 and 7 at one and five minutes was delivered.


CONCLUSIONS
Aortic dissection in pregnancy may have catastrophic results. Undoubtedly, it presents unique challenges for anesthetic and obstetrical management. With appropriate care and surgical correction of the dissecting aneurysm early in pregnancy, a successful outcome for the pregnancy was possible.
Tilak
Monala
M
Department of Anesthesiology, University of Oklahoma Health Sciences Centre, Oklahoma City, OK 73104, USA. Monala-tilak@ouhsc.edu
Smith
Jacqueline
J
Rogers
Dan
D
Fox
Pamela
P
Muntazar
Muhammad
M
Peyton
Marvin
M
D000328:Adult; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002585:Cesarean Section; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures