Successful treatment for acute aortic dissection in pregnancy---bentall procedure concomitant with cesarean section

Acute aortic type A dissection in pregnancy is rare, however, of high risk for both the mother and the fetus. Concomitant diseases of Marfan and bicuspid aortic valve disease (BAVD) are of special interest. From Jan 2001 to April 2008, we had two cases of acute aortic dissection in pregnancy (one BAVD patient, and the other Marfan patient), 1.38% (2/145) in all acute aortic type A dissection cases.Case I. A 33-year-old Marfan woman, who had had a normal previous pregnancy, was referred because of the acute chest pain with back irradiation. She was at the 28 weeks' pregnancy this time. Echocardiography revealed moderate-severe aortic regurgitation, a dilated aortic root measuring 5.2 cm in diameter, and an acute aortic dissection involving the ascending aorta and the aortic arch, which was also verified by a computed tomography arteriogram (Figure 1-A, B).Case II. A 30-year-old woman at 32 weeks of gestation was admitted because of the acute onset of severe chest pain and dyspnea. Her chest x-ray revealed an enlarged heart shadow and widening of the mediastinum. Echocardiography revealed BAVD (Figure 2-A) with moderate aortic stenosis and regurgitation, a dilated aortic root measuring 4.6 cm in diameter, and an acute aortic dissection involving the ascending aorta, which was also verified by a computed tomography arteriogram (Figure 2-B).These two patients had a negative history of vascular events, high blood pressure, and previous vascular surgery. Under general anesthesia, the cardiopulmonary bypass was built by draining from right atrium and perfusion into the femoral artery or axillary artery. Cesarean section was performed immediately followed by Bentall procedure. After 24 hours of a regular intensive care unit (ICU) postoperative period, the patients were transferred to the ward and then discharged on the 7th postoperative day.Aortic dissection is rare in young woman, but when it does occur, it is often associated with pregnancy of highest incidence in the thi