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2019, vol. 147, iss. 3-4, pp. 205-210
Pregnant woman survives aortic dissection, dies later of coronary embolism: A unique case of a non-compliant patient
University of Novi Sad, Faculty of Medicine + University of Novi Sad, Faculty of Medicine, Institute for Cardiovascular Disease
Keywords: aortic dissection; pregnancy; anticoagulation therapy; prosthetic valve thrombosis; coronary embolism
Introduction the incidence of aortic dissection ranges 3-5 cases per 100,000 person-years. In women under the age of 40 who acquire aortic dissection, almost half of the cases happen during pregnancy. Case outline We report a case of a 22-year-old pregnant woman in the 16th gestational week with a history of arterial hypertension and known aortic dilatation, who was admitted with aortic dissection. She underwent the Bentall procedure, in which her aortic valve, ascending aorta, and proximal part of the aortic arch were replaced using valved composite graft. On the next day, the evacuation abortion was made, since the fetus didn't survive the operation. Six years later, the patient stopped taking anti-coagulation therapy and was admitted for prosthetic valve thrombosis, which was successfully treated with intravenous heparin. One year later, the patient died of a myocardial infarction due to coronary thromboembolism, confirmed on autopsy. Conclusion Preconceptional counseling in women with a known aortic disease is of the utmost importance. Aortic dissection in pregnant women is an acute life-threatening condition for both mother and fetus that should be managed by a multidisciplinary team. After a mechanical heart valve implantation, lifetime oral anticoagulants are mandatory.
Al, K.K.A.J., Sequeira, R.P., Alkhaja, A.K., Damanhori, A.H.H. (2014) Drug treatment of hypertension in pregnancy. Journal of Hypertension, 32(3): 454-463
American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy (2013) Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol, 122(5): 1122-31
Ammash, N.M., Sundt, T.M., Connolly, H.M. (2008) Marfan Syndrome—Diagnosis and Management. Current Problems in Cardiology, 33(1): 7-39
Atta, E., Gardner, M. (2007) Cardiopulmonary Resuscitation in Pregnancy. Obstetrics and Gynecology Clinics of North America, 34(3): 585-597
Barrus, A., Afshar, S., Sani, S., LaBounty, T.G., Padilla, C., Farber, M.K., Rudikoff, A.G., Hernandez, C.A. (2018) Acute Type A Aortic Dissection and Successful Surgical Repair in a Woman at 21 Weeks Gestational Pregnancy With Maternal and Fetal Survival: A Case Report. Journal of Cardiothoracic and Vascular Anesthesia, 32(3): 1487-1493
Erbel, R., i dr. (2014) 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. European Heart Journal, 35(41): 2873-2926
Evangelista, A., Flachskampf, F. A., Erbel, R., Antonini-Canterin, F., Vlachopoulos, C., Rocchi, G., Sicari, R., Nihoyannopoulos, P., Zamorano, J., Pepi, M., Breithardt, O.-A., Plonska-Gosciniak, E. (2010) Echocardiography in aortic diseases: EAE recommendations for clinical practice. European Journal of Echocardiography, 11(8): 645-658
Guo, C., Xu, D., Wang, C. (2011) Successful treatment for acute aortic dissection in pregnancy-bentall procedure concomitant with cesarean section. Journal of Cardiothoracic Surgery, 6(1): 139
Hagan, P.G., Nienaber, C.A., Isselbacher, E.M., Bruckman, D., Karavite, D.J., Russman, P.L., Evangelista, A., Fattori, R., Suzuki, T., Oh, J.K., Moore, A.G., Malouf, J.F., Pape, L.A., Gaca, C. (2000) The International Registry of Acute Aortic Dissection (IRAD). JAMA, 283(7): 897-903
Ham, S. (2010) Emergency repair of aortic dissection in a 37-week parturient: a case report. AANA J., 78(1): 63-8
Hiratzka, L., i dr. (2010) ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/ SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. Catheter Cardiovasc Interv., 76(2):E43-86
Ilic, A., Ilic, DJ., Tadic, S., Stefanovic, M., Stojsic-Milosavljevic, A., Pavlovic, K., Redzek, A., Velicki, L. (2017) Influence of non-dipping pattern of blood pressure in gestational hypertension on maternal cardiac function, hemodynamics and intrauterine growth restriction. Pregnancy Hypertension, 10(): 34-41
Immer, F.F., Bansi, A.G., Immer-Bansi, A.S., McDougall, J., Zehr, K.J., Schaff, H.V., Carrel, T.P. (2003) Aortic dissection in pregnancy: analysis of risk factors and outcome. Annals of Thoracic Surgery, 76(1): 309-314
Junqueira, D.R., Perini, E., Penholati, R.R., Carvalho, M.G. (2012) Unfractionated heparin versus low molecular weight heparin for avoiding heparin-induced thrombocytopenia in postoperative patients. Cochrane Database of Systematic Reviews, (9):CD007557
Khan, I.A., Nair, C.K. (2002) Clinical, Diagnostic, and Management Perspectives of Aortic Dissection. Chest, 122(1): 311-328
Kohli, E., Jwayyed, S., Giorgio, G., Bhalla, M.C. (2013) Acute Type A Aortic Dissection in a 36-Week Pregnant Patient. Case Reports in Emergency Medicine, 2013(): 1-3
Liu, Y., Li, H., Jiang, W., Guan, X., Wang, X., Liu, O., Zhu, J., Sun, L., Zhang, H. (2017) Treatment of patients with aortic disease during pregnancy and after delivery. Journal of International Medical Research, 45(4): 1359-1368
Loeys, B. L., Dietz, H. C., Braverman, A. C., Callewaert, B. L., de Backer, J., Devereux, R. B., Hilhorst-Hofstee, Y., Jondeau, G., Faivre, L., Milewicz, D. M., Pyeritz, R. E., Sponseller, P. D., Wordsworth, P., de Paepe, A. M. (2010) The revised Ghent nosology for the Marfan syndrome. Journal of Medical Genetics, 47(7): 476-485
Mandel, W., Evans, E. W., Walford, R. L. (1954) Dissecting Aortic Aneurysm during Pregnancy. New England Journal of Medicine, 251(26): 1059-1061
Mészáros, I., Mórocz, J., Szlávi, J., Schmidt, J., Tornóci, L., Nagy, L., Szép, L. (2000) Epidemiology and Clinicopathology of Aortic Dissection. Chest, 117(5): 1271-1278
Mookhoek, A., Korteland, N.M., Arabkhani, B., di Centa, I., Lansac, E., Bekkers, J.A., Bogers, A.J.J.C., Takkenberg, J.J.M. (2016) Bentall Procedure: A Systematic Review and Meta-Analysis. Annals of Thoracic Surgery, 101(5): 1684-1689
Nardi, P., Russo, M., Greci, M., Pisano, C., Saitto, G., Pellegrini, G., et al. (2018) Acute Myocardial Infarction Ten Days after Bentall Procedure due to Coronary Embolism: Etiology Discussion and Rare Case Presentation. Clin Surg., 3: 2136
Nishimura, R.A., Otto, C.M., Bonow, R.O., Carabello, B.A., Erwin, J.P., Guyton, R.A., O’Gara, P.T., Ruiz, C.E., Skubas, N.J., Sorajja, P., Sundt, T.M., Thomas, J.D. (2014) 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. Circulation, 129(23): 2440-2492
Pomini, F., Mercogliano, D., Cavalletti, C., Caruso, A., Pomini, P. (1996) Cardiopulmonary bypass in pregnancy. Ann Thorac Surg., 61(1): 259-68
Preveden, A., Kovacevic, M., Susak, S., Redzek, A., Velicki, L. (2018) Coronary embolism causing myocardial infarction after heart valve surgery. Vojnosanitetski pregled, (00): 180-180
Senguttuvan, N.B., Ramakrishnan, S., Singh, S., Mishra, S. (2015) Percutaneous management of coronary embolism with prosthetic heart valve thrombosis after Bentall's procedure. Indian Heart Journal, 67(6): 589-591
Shaker, W.H., Refaat, A.A., Hakamei, M.A., Ibrahim, M.F. (2008) Acute Type A Aortic Dissection at Seven Weeks of Gestation in a Marfan Patient: Case Report. Journal of Cardiac Surgery, 23(5): 569-570
Shibata, T., Kawakami, S., Noguchi, T., Tanaka, T., Asaumi, Y., Kanaya, T., Nagai, T., Nakao, K., Fujino, M., Nagatsuka, K., Ishibashi-Ueda, H., Nishimura, K., Miyamoto, Y. (2015) Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism. Circulation, 132(4): 241-250
Task Force for the management of arterial hypertension of the European Society of Hypertension, Task Force for the management of a (2013) 2013 ESH/ESC Guidelines for the Management of Arterial Hypertension. Blood press, 22(4): 193-278
Vasiljević, Z., Dimković, N., Lazarević, K., Burmazović, S., Krstić, N., Milanović, S., Zorić, S., Micić, D. (2013) Postmarketing study of efficacy and safety of losartan during the treatment of patients with mild and moderate hypertension: Lothar study. Srpski arhiv za celokupno lekarstvo, vol. 141, br. 1-2, str. 22-28


article language: English
document type: Case Report
DOI: 10.2298/SARH180521007P
published in SCIndeks: 07/07/2019

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