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Outcomes of Pregnancy-Related Acute Aortic Dissection
Quick Takes
- There is a strong link between underlying aortopathy and aortic dissection related to pregnancy.
- Women with aortopathies should receive multidisciplinary evaluation and counseling before pregnancy, including maternal and fetal risk.
- Early recognition of underlying conditions and risks for aortic dissection may improve management and outcomes of pregnancy in women with aortopathy.
Study Questions:
What are the clinical characteristics, imaging features, and outcomes in women with pregnancy-related acute aortic dissection?
Methods:
The investigators conducted a cohort study, using data from the International Registry of Acute Aortic Dissection (IRAD) (February 1, 1998–February 28, 2018). The multicenter referral center study included 29 women with aortic dissection during pregnancy or <12 weeks post-partum in IRAD from 1998–2018. The main outcome measures were clinical features of pregnancy-related aortic dissection including underlying aortopathy, aortic size, type of aortic dissection, timing of dissection, hypertension, and previous aortic surgery.
Results:
A total of 29 women (mean [standard deviation (SD)] age, 32 [6] years) had pregnancy-related aortic dissection, representing 0.3% of all aortic dissections and 1% of aortic dissection in women in the IRAD. Among women <35 years, aortic dissection was related to pregnancy in 20 of 105 women (19%). Thirteen women (45%) had type A aortic dissection, and 16 women (55%) had type B. Aortic dissection onset was known in 27 women (93%): 15 during pregnancy, four in the first trimester, and 11 in the third trimester; 12 were post-partum, occurring a mean (SD) of 12.5 (14) days post-partum. At type A aortic dissection diagnosis, the mean (SD) aortic diameters were sinus of Valsalva, 54.5 (5) mm and ascending aorta, 54.7 (6) mm. At type B aortic dissection diagnosis, the mean (SD) descending aortic diameter was 32.5 (5) mm. Twenty women (69%) had an aortopathy condition or a positive family history: 13 women (65%) with Marfan syndrome, two women (10%) with Loeys-Dietz syndrome, two women (10%) with bicuspid aortic valves, two women (10%) with a family history of aortic disease, and one woman (5%) with familial thoracic aortic aneurysm. Aortopathy was not recognized until after aortic dissection in 47% of the women. Twenty-eight women (97%) survived aortic dissection hospitalization.
Conclusions:
The authors concluded that most pregnancy-related aortic dissection is due to an aortopathy often not diagnosed until after aortic dissection.
Perspective:
This IRAD study represents one of the largest analyses to date of pregnancy-related acute aortic dissection and reports a strong link between underlying aortopathy and aortic dissection related to pregnancy. These data suggest that women with aortopathies should receive multidisciplinary evaluation and counseling before pregnancy, including maternal and fetal risk. For some women with significant aortic dilatation, prophylactic aortic root and/or ascending aortic replacement before pregnancy may be reasonable, while for some, pregnancy should be avoided. Overall, early recognition of underlying conditions and risks for aortic dissection may improve management and outcomes of pregnancy in women with aortopathy.
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Hypertension
Keywords: Aneurysm, Dissecting, Aortic Aneurysm, Thoracic, Cardiac Surgical Procedures, Diagnostic Imaging, Dilatation, Heart Defects, Congenital, Heart Valve Diseases, Hypertension, Loeys-Dietz Syndrome, Marfan Syndrome, Outcome Assessment, Health Care, Pregnancy, Secondary Prevention, Sinus of Valsalva, Vascular Diseases
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