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一名患有未确诊马凡综合征的孕妇发生急性B型主动脉夹层:病例报告及文献复习

Acute type B aortic dissection in a pregnant woman with undiagnosed Marfan syndrome: A case report and review of the literature.

作者信息

Miyazaki Yumiko, Orisaka Makoto, Kato Masataka, Kawamura Hiroshi, Kurokawa Tetsuji, Yoshida Yoshio

机构信息

Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Japan.

出版信息

Case Rep Womens Health. 2021 Jul 16;32:e00342. doi: 10.1016/j.crwh.2021.e00342. eCollection 2021 Oct.

Abstract

Aortic dissection during pregnancy is rare but can be life-threatening to both the mother and the foetus. Marfan syndrome is a major risk factor for acute aortic dissection during pregnancy. Here, we present the case of a woman who had not been diagnosed with Marfan syndrome prior to pregnancy and who developed acute type B dissection at 32 weeks of gestation. The maternal hemodynamic status was stable, and foetal well-being was ensured. However, under conservative treatment, the dissection extended to the descending aorta, reaching the bilateral iliac artery 2 days later. Due to foetal distress, preterm delivery was performed via caesarean section. The primary treatment of type B aortic dissection is conservative medical treatment, with the goals of hemodynamic stabilisation, minimising the extent of the dissection and decreasing the risk of rupture. However, type B aortic dissection, even the uncomplicated type, in pregnant women may require early and aggressive obstetric interventions to improve maternal and foetal prognoses.

摘要

妊娠期主动脉夹层很少见,但对母亲和胎儿都可能危及生命。马凡综合征是妊娠期急性主动脉夹层的主要危险因素。在此,我们报告一例在妊娠前未被诊断为马凡综合征的女性病例,该女性在妊娠32周时发生了急性B型夹层。母亲的血流动力学状态稳定,胎儿状况良好得到确保。然而,在保守治疗下,夹层扩展至降主动脉,2天后累及双侧髂动脉。由于胎儿窘迫,通过剖宫产进行了早产。B型主动脉夹层的主要治疗方法是保守药物治疗,目标是实现血流动力学稳定、尽量减少夹层范围并降低破裂风险。然而,孕妇的B型主动脉夹层,即使是无并发症的类型,可能也需要早期积极的产科干预,以改善母婴预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3551/8325095/5f022ba0d85b/gr1.jpg

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