Easo Jerry, Horst Michael, Schmuck Bernhard, Thomas Rohit Philip, Saupe Steffen, Book Malte, Weymann Alexander
Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Rahel Straus Str. 10, 26133, Oldenburg, Germany.
Department of Diagnostic and Interventional Radiology, European Medical School Oldenburg-Groningen, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
J Cardiothorac Surg. 2018 May 2;13(1):36. doi: 10.1186/s13019-018-0724-7.
Type A Dissection in pregnancy is a devastating medical condition with 2 lives at stake and unclear strategy at early gestational stages. We describe a successful outcome, clearly dependent on the coordination of all involved disciplines.
This case history describes a 28 year old female with a 24th week pregnancy gravida 2 para 0 with a DeBakey Type I aortic dissection, diagnosed via ultrasound. Surgery was perfomed on the day of diagnosis. After conferral with the mother, caesarean section was performed and a 690 g fetus could be delivered and was immediately transferred to the neonatal unit. Subsequent aortic repair was performed after hysterectomy, with replacement of the ascending aorta and hemiarch treatment. Intraoperatively no entry in the ascending aorta or transverse arch could be demonstrated, so that a retrograde Type A with entry distal to the left subclavian had to be postulated. We decided to perform subsequent computer tomography, demonstrating multiple entry sites in the descending aorta distal to the left subclavian artery. Successful endovascular treatment could be performed with a Medtronic Valiant Stent via a transfemoral approach. The further hospital stay was uneventful and the patient could be discharged on the 18th postoperative day. The baby demonstrated fighter qualities and could be discharged home after a 3 month hospital stay to be reunited with his mother.
Prompt diagnosis, precise coordination between all involved subspecialties and ultimately, as in this case, definitive treatment in consensus with operative and interventional departments have led to a successful outcome and encourages us in our daily struggle in this often demanding surgery.
妊娠期A型主动脉夹层是一种严重的医学状况，涉及两条生命，且妊娠早期的治疗策略尚不明确。我们描述了一个成功的案例，其明显依赖于所有相关学科的协作。
本病例报告描述了一名28岁、孕24周、孕2产0的女性，经超声诊断为DeBakey I型主动脉夹层。诊断当天即进行了手术。与产妇商议后，实施了剖宫产，娩出一个690克的胎儿，并立即转至新生儿病房。子宫切除术后进行了主动脉修复，置换了升主动脉并处理了半弓。术中未发现升主动脉或横弓有破口，因此推测为左锁骨下动脉远端破口的逆行性A型夹层。我们决定随后进行计算机断层扫描，结果显示左锁骨下动脉远端的降主动脉有多个破口。通过经股动脉途径，使用美敦力勇士支架成功实施了血管内治疗。术后进一步住院期间情况平稳，患者于术后第18天出院。婴儿表现出顽强的生命力，住院3个月后出院回家与母亲团聚。
及时诊断、所有相关亚专业之间的精确协作，以及最终如本病例所示，与手术和介入科室达成共识进行确定性治疗，带来了成功的结果，并激励我们在这种通常要求很高的手术中不断努力。
