Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
Tex Heart Inst J. 2023 Jan 1;50(1). doi: 10.14503/THIJ-22-7854.
Between 0.1% and 0.3% of all aortic dissections occur during pregnancy. Arterial hypertension, connective tissue disorders, and congenital cardiovascular anomalies-including bicuspid aortic valves-are well-known risk factors. The causality between pregnancy and aortic dissection is unclear, but there have been some observations that COVID-19 illness may increase the risk. This report describes a pregnant woman at 34 weeks of gestation who had a bicuspid aortic valve and experienced an acute aortic dissection while ill with COVID-19 pneumonia. Computed tomography confirmed a type A aortic dissection and bilateral patchy pulmonary opacities. Cesarean delivery was performed, followed by replacement of the aortic valve with a mechanical aortic prosthesis and reconstruction of the ascending aorta and hemiarch. The intraoperative course was uneventful, and the patient was successfully weaned from mechanical ventilation after 51 hours. COVID-19 during pregnancy seems to increase the risk for aortic dissection, although there is no evidence base for an association. Because guidelines for diagnosis and treatment in such complex cases are lacking, care from a multidisciplinary team is crucial for successful outcomes.
在所有主动脉夹层中，0.1%至0.3%发生在怀孕期间。动脉高血压、结缔组织疾病和先天性心血管异常，包括二叶式主动脉瓣，都是众所周知的风险因素。怀孕期间发生主动脉夹层的因果关系尚不清楚，但有一些观察结果表明，COVID-19 疾病可能会增加这种风险。本报告描述了一位怀孕 34 周的孕妇，她患有二叶式主动脉瓣，并在患有 COVID-19 肺炎时发生急性主动脉夹层。计算机断层扫描（CT）证实为 A 型主动脉夹层和双侧斑片状肺不张。行剖宫产术，随后用机械主动脉瓣置换术置换主动脉瓣，并重建升主动脉和半弓。术中过程顺利，患者在机械通气 51 小时后成功脱机。怀孕期间的 COVID-19 似乎会增加主动脉夹层的风险，尽管目前没有证据表明两者之间存在关联。由于缺乏针对此类复杂病例的诊断和治疗指南，多学科团队的护理对于获得成功的结果至关重要。
