Zeebregts C J, Schepens M A, Hameeteman T M, Morshuis W J, de la Rivière A B
Department of Cardiopulmonary Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Ann Thorac Surg. 1997 Nov;64(5):1345-8. doi: 10.1016/S0003-4975(97)00916-8.
Acute aortic dissection occurring during pregnancy represents a lethal risk to both the mother and fetus. Our purpose was to study the prevalence, treatments, and outcome of this rare problem and to suggest therapeutic guidelines.
During the past 12 years, 6 pregnant women were admitted with an acute aortic dissection. Four had a type A and 2 had a type B dissection (Stanford classification).
Two of the 4 patients with a type A dissection underwent a combined emergency operation consisting of first cesarean section and then ascending aortic repair. Cesarean section was carried out 5 days after the emergency procedure on the aorta in the third patient, and 16 weeks later in the fourth patient. All 4 fetuses were delivered alive. One fetus died 6 days later, but the other 3 are alive and well at long-term follow-up. Of the 2 patients with a type B dissection, 1 was operated on for celiac ischemia; the other was treated medically. In both cases the fetus died in utero. There were no maternal deaths in either group.
Cesarean section with concomitant aortic repair is recommended for pregnant women with a type A dissection, depending on the gestational age. The maternal hemodynamic status will determine the sequence of the two procedures. Medical treatment is advised for patients with a type B dissection, but surgical repair is indicated if complications such as bleeding or malperfusion of major side branches occur.
妊娠期发生急性主动脉夹层对母亲和胎儿均构成致命风险。我们的目的是研究这一罕见问题的患病率、治疗方法及结局，并提出治疗指南。
在过去12年中，6例孕妇因急性主动脉夹层入院。4例为A型夹层，2例为B型夹层（斯坦福分类）。
4例A型夹层患者中有2例接受了联合急诊手术，先进行剖宫产，然后进行升主动脉修复。第3例患者在主动脉急诊手术后5天进行剖宫产，第4例患者在16周后进行剖宫产。所有4例胎儿均存活分娩。1例胎儿在6天后死亡，但其他3例在长期随访中存活且状况良好。2例B型夹层患者中，1例因腹腔缺血接受手术；另1例接受药物治疗。两例患者的胎儿均死于宫内。两组均无孕产妇死亡。
对于A型夹层的孕妇，建议根据孕周进行剖宫产并同时进行主动脉修复。孕产妇的血流动力学状态将决定这两个手术的顺序。对于B型夹层患者，建议进行药物治疗，但如果出现出血或主要分支血管灌注不良等并发症，则需进行手术修复。
