Should pregnancy be considered a risk factor for aortic dissection? Two cases of acute aortic dissection following cesarean section in non-Marfan nor bicuspid aortic valve patients.
Acute aortic dissection in pregnancy is a rare event and rarer still in healthy young women; however, women with a bicuspid aortic valve or the Marfan syndrome are at a higher risk of dissection. The relationship between pregnancy and aortic dissection is still unclear. We describe the cases of two women with no history of cardiovascular disease who developed an acute aortic type A dissection within a few days after term delivery. Surgical repair was performed with ascending aorta replacement and aortic valve sparing. In both cases, the dissection was diagnosed within a few days following cesarean section done neither because of fetal or maternal distress. To date, only one case of type A and two cases of type B aortic dissection following cesarean section have been reported. Compared with spontaneous delivery, scheduled cesarean section, as in our cases, allows for better control of hemodynamic parameters and should protect against aortic dissection. Postoperative screening for inherent connective tissue disorders detected no mutations within the fibrillin and collagen gene chromosome in either patient. Postoperative recovery was uneventful, and the patients were discharged on postoperative days 7 and 8, respectively.
Gelpi
G
G
Cardiovascular Division, L. Sacco Hospital, University of Milan, Milan, Italy. g.gelpi@hsacco.it
Pettinari
M
M
Lemma
M
M
Mangini
A
A
Vanelli
P
P
Antona
C
C
D000208:Acute Disease; D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities; D002585:Cesarean Section; D005260:Female; D006801:Humans; D008382:Marfan Syndrome / Q000150:complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000601:surgery; D012307:Risk Factors