Successful near-term pregnancy outcome after repair of a dissecting thoracic aortic aneurysm at 14 weeks gestation

Monala Tilak, Jacqueline Smith, Dan Rogers, Pamela Fox, Muhammad Muntazar, Marvin Peyton

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Purpose: We report the anesthetic management for a scheduled Cesarean section of a 29-yr-old female who previously had a repair of her dissecting thoracic aortic aneurysm during the 14th week of her pregnancy. Clinical features: A 29-yr-old female with a history of hypertension and previously diagnosed aortic dissection secondary to suspected Marfan's syndrome, presented to our institution for the first time after she became pregnant. A transesophageal echocardiogram revealed a dissecting aortic aneurysm greater than 8 cm in diameter beginning distal to the left subclavian artery and extending into the descending thoracic aorta. The patient was counseled in great detail about the risk of rupture with continuing pregnancy. She refused termination and chose elective repair of the aneurysm, with continuation of the pregnancy. Partial repair of the thoracic aneurysm was undertaken when the pregnancy was 135/7 weeks by ultrasound dates. She was subsequently maintained on labetolol and hydralazine for blood pressure control. A decision was made to proceed with a Cesarean section at 32 weeks. After placement of a radial artery catheter and two large peripheral iv catheters, she received a combined spinal-epidural anesthetic. A male infant with Apgars of 7 and 7 at one and five minutes was delivered. Conclusions: Aortic dissection in pregnancy may have catastrophic results. Undoubtedly, it presents unique challenges for anesthetic and obstetrical management. With appropriate care and surgical correction of the dissecting aneurysm early in pregnancy, a successful outcome for the pregnancy was possible.

Original languageEnglish (US)
Pages (from-to)1071-1075
Number of pages5
JournalCanadian Journal of Anesthesia
Volume52
Issue number10
DOIs
StatePublished - Dec 1 2005

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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