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

[Dénouement heureux d’une grossesse menée presque à terme à la suite de la réparation d’un anévrysme disséquant de l’aorte thoracique à 14 semaines de gestation]

From the Department of Anesthesiology, University of Oklahoma Health Sciences Centre, Oklahoma City, Oklahoma, USA.

Address correspondence to: Dr. Monala Tilak, Department of Anesthesiology, University of Oklahoma Health Sciences Centre, 920 Stanton L. Young Blvd., Room WP 2530, Oklahoma City, OK 73104, USA. Phone: 405-271-4351; Fax: 405-271-8695; E-mail: Monala-tilak{at}ouhsc.edu

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 14^th 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 13^5/7 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 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.