Tarnowska Julia, Gąsiorowski Oskar, Leszczyński Jerzy, Stępkowski Kamil, Gałązka Zbigniew, Romejko-Wolniewicz Ewa
Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland.
II Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.
Am J Case Rep. 2025 May 13;26:e947148. doi: 10.12659/AJCR.947148.
BACKGROUND Type B aortic dissection occurring after labor can be life-threatening. Severe hypertension is among the main risk factors. This report highlights the role of early intervention and special monitoring of pregnant women, and their effects on symptoms. CASE REPORT A 28-year-old women with a history of hypertension was admitted to the obstetrics hospital. Two attempts at labor induction were unsuccessful. A decision was made to proceed with a cesarean section. Due to the patient's deteriorating condition, 2 laparotomies were performed, 1 at the initial hospital and another after transfer. Postoperatively, she required intensive care monitoring. Based on imaging studies, a diagnosis of type B thoracoabdominal aortic dissection complicated by malperfusion was established. Endovascular aortic repair involved placement of an aortic stent graft under imaging guidance. A Zenith TX2 Dissection endovascular stent graft with a Pro Form Z-Track Plus delivery system was introduced. Afterward, the patient underwent 2 more surgeries: duodenum resection and creation of a gastro-descending colon anastomosis. Upon hospital admission, the patient was in very serious general condition. However, after 2 months of treatment and improvement, she was discharged. CONCLUSIONS This report demonstrates that hypertension during pregnancy, combined with unsuccessful attempts at delivery, may be a significant risk factor for aortic dissection. Effective diagnosis and management of these patients is challenging and requires multidisciplinary care, including the use of computed tomography with contrast as soon as possible due to its higher benefits, and the immediate endovascular approach as the safest method of treating postpartum aortic dissection.
背景 分娩后发生的B型主动脉夹层可能危及生命。严重高血压是主要危险因素之一。本报告强调了对孕妇进行早期干预和特殊监测的作用及其对症状的影响。病例报告 一名有高血压病史的28岁女性入住产科医院。两次引产尝试均未成功。决定进行剖宫产。由于患者病情恶化，进行了两次剖腹手术，一次在初始医院，另一次在转院后。术后，她需要重症监护监测。根据影像学检查，确诊为B型胸腹主动脉夹层合并灌注不良。血管腔内主动脉修复术包括在影像学引导下放置主动脉覆膜支架。引入了带有Pro Form Z-Track Plus输送系统的Zenith TX2夹层血管腔内支架移植物。此后，患者又接受了两次手术：十二指肠切除术和胃-降结肠吻合术。入院时，患者全身状况非常严重。然而，经过2个月的治疗和好转后，她出院了。结论 本报告表明，孕期高血压加上分娩尝试失败可能是主动脉夹层的重要危险因素。对这些患者进行有效的诊断和管理具有挑战性，需要多学科护理，包括由于其更高的益处而尽快使用增强计算机断层扫描，以及将立即采用血管腔内治疗方法作为治疗产后主动脉夹层的最安全方法。
