Vascular Surgery Department, Royal Blackburn Teaching Hospital, Blackburn, UK.
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
J Card Surg. 2021 Apr;36(4):1232-1240. doi: 10.1111/jocs.15354. Epub 2021 Feb 2.
Type B aortic dissection (TBAD) occurs seldomly, particularly in pregnancy, but has disastrous consequences for both mother and fetus. The focus of immediate surgical repair of type A aortic dissection due to higher mortality of patients is less clear in its counterpart, TBAD, in which management is controversial and debated. This article collates knowledge so far on this rare event during pregnancy.
A comprehensive literature search was performed in PubMed, Scopus, Google Scholar, Embase, and Medline. Key search terms included "type B aortic dissection," "pregnancy," and corresponding synonyms. Non-English papers were excluded.
Risk factors for TBAD include aortic wall stress due to hypertension, previous cardiac surgery, structural abnormalities (bicuspid aortic valve, aortic coarctation), and connective tissue disorders. In pregnancy, pre-eclampsia is a cause of increased aortic wall stress. Management of this condition is often conservative, but this is dependent on a number of factors, including gestation, cardiovascular stability of the patient, and symptomology. In most cases, a cesarean section before intervention is carried out unless certain indications are present.
Due to a scarce number of cases across the decades, it is difficult to determine which management is optimal. The gold-standard management of TBAD has traditionally been the medical treatment for uncomplicated cases and open surgery for those needing urgent intervention, but with the advent of techniques, such as thoracic endovascular aortic repair, the management of these group of patients continues to develop.
B 型主动脉夹层（TBAD）很少见，特别是在妊娠期间，但对母亲和胎儿都有灾难性的后果。由于患者死亡率较高，A型主动脉夹层的立即手术修复焦点更为明确，但在 TBAD 中，其治疗方法存在争议，目前尚无定论。本文就妊娠期间这一罕见事件的现有知识进行了综述。
在 PubMed、Scopus、Google Scholar、Embase 和 Medline 中进行了全面的文献检索。主要检索词包括“B 型主动脉夹层”、“妊娠”和相应的同义词。排除非英语论文。
TBAD 的危险因素包括高血压引起的主动脉壁应力、既往心脏手术、结构异常（二叶式主动脉瓣、主动脉缩窄）和结缔组织疾病。在妊娠期间，先兆子痫是导致主动脉壁应力增加的一个原因。这种情况的治疗通常是保守的，但这取决于许多因素，包括妊娠、患者心血管稳定性和症状。在大多数情况下，除非存在某些指征，否则在进行干预之前会进行剖宫产。
由于数十年来病例数量稀少，很难确定哪种治疗方法是最佳的。TBAD 的黄金标准治疗传统上是对无并发症病例进行药物治疗，对需要紧急干预的病例进行开放性手术，但随着技术的出现，如胸主动脉腔内修复术，这些患者的治疗方法仍在不断发展。
