Rommens Kenton L, Sandhu Harleen K, Miller Charles C, Cecchi Alana C, Prakash Siddharth K, Saqib Naveed U, Charlton-Ouw Kristofer M, Milewicz Dianna M, Estrera Anthony L, Safi Hazim J, Afifi Rana O
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Tex.
Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Tex.
J Vasc Surg. 2021 Oct;74(4):1135-1142.e1. doi: 10.1016/j.jvs.2021.03.028. Epub 2021 Apr 20.
In the present study, we defined the outcomes and effects of pregnancy in a cohort of women of childbearing age with acute aortic dissection (AAD).
We reviewed our database of AAD to identify all eligible female patients. Women aged <45 years were included. Data on pregnancy timing with respect to the occurrence of dissection, the demographic data, dissection extent, dissection treatment, dissection-related outcomes, overall maternal and fetal mortality, and genetic testing results were analyzed.
A total of 62 women aged <45 years had presented to us with AAD from 1999 to 2017. Of the 62 women, 37 (60%) had had a history of pregnancy at AAD. Of these 37 patients, 10 (27%) had had a peripartum aortic dissection, defined as dissection during pregnancy or within 12 months postpartum. Of the 10 AADs, 5 were type A and 5 were type B. Three patients had presented with AAD during pregnancy (one in the second and two in the third trimester). Five patients (50%) had developed AAD in the immediate postpartum period (within 3 months) and two (20%) in the late postpartum period. For the immediate postpartum AADs (<3 months), four of the five patients delivered via cesarean section. Of these 10 peripartum AADs, 3 (30%) had occurred in patients with known Marfan syndrome. In-hospital mortality for those with peripartum AAD was 10% (1 of 10). Fetal mortality was 20% (2 of 10).
The frequency of aortic dissection in women of childbearing age at our institution was low. However, pregnancy might increase the risk of those young women genetically predisposed to dissection events. From these data, this risk appears to be greatest in the immediate postpartum period, even for those who undergo cesarean section. Close clinical and radiographic surveillance is required for all women with suspected aortopathy, especially in the third trimester and early postpartum period.
在本研究中，我们明确了一群育龄期急性主动脉夹层（AAD）女性患者妊娠的结局和影响。
我们查阅了AAD数据库以确定所有符合条件的女性患者。纳入年龄小于45岁的女性。分析了与夹层发生相关的妊娠时间、人口统计学数据、夹层范围、夹层治疗、夹层相关结局、孕产妇和胎儿总体死亡率以及基因检测结果。
1999年至2017年期间，共有62名年龄小于45岁的女性因AAD前来就诊。在这62名女性中，37名（60%）在发生AAD时有妊娠史。在这37名患者中，10名（27%）发生了围产期主动脉夹层，定义为在妊娠期或产后12个月内发生的夹层。在这10例AAD中，5例为A型，5例为B型。3例患者在妊娠期发生AAD（1例在孕中期，2例在孕晚期）。5例患者（50%）在产后即刻（3个月内）发生AAD，2例（20%）在产后晚期发生。对于产后即刻AAD（<3个月），5例患者中有4例通过剖宫产分娩。在这10例围产期AAD中，3例（30%）发生在已知马凡综合征的患者中。围产期AAD患者的院内死亡率为10%（10例中的1例）。胎儿死亡率为20%（10例中的第2例）。
我院育龄期女性主动脉夹层的发生率较低。然而，妊娠可能会增加那些有夹层事件遗传易感性的年轻女性的风险。从这些数据来看，这种风险在产后即刻似乎最大，即使是那些接受剖宫产的女性。对于所有疑似主动脉病变的女性，尤其是在孕晚期和产后早期，需要密切的临床和影像学监测。
