BACKGROUND AND PURPOSE:

• Braverman et al. (JAMA Cardiol., 2020) examined clinical characteristics, imaging features, and outcomes in women with pregnancy-related acute aortic dissection

METHODS:

• Cohort study (February 1, 1998 to February 28, 2018)
• Data source
  • International Registry of Acute Aortic Dissection (IRAD)
• Participants
  • Women with aortic dissection during pregnancy or <12 weeks postpartum
• Primary outcomes
  • Clinical features of pregnancy-related aortic dissection: Underlying aortopathy | Aortic size | Type of aortic dissection | Timing of dissection | Hypertension | Previous aortic surgery

RESULTS:

• 29 women with pregnancy-related aortic dissection were included
  • Mean (SD) age: 32 (6) years
    • 0.3% of all aortic dissections
    • 1% of aortic dissection in women in the IRAD
  • Age: 19% <35 years
• Aortic dissection type
  • Type A (ascending aorta involved): 45%
  • Type B (ascending aorta not involved): 55% of women
• Aortic dissection onset
  • During pregnancy: 15 women
    • First trimester: 4 women
    • Third trimester: 11 women
  • Postpartum: 12 women
    • Occurred a mean (SD) of 12.5 (14) days postpartum
• Aortic diameters
  • Type A diagnosis
    • Sinus of Valsalva: mean (SD) 54.5 (5) mm
    • Ascending aorta: 54.7 (6) mm
  • Type B diagnosis
    • Descending aorta: 32.5 (5) mm
• Aortopathy condition or a positive family history present in 69%
  • Marfan syndrome: 65%
  • Loeys-Dietz syndrome: 10%
  • Bicuspid aortic valves: 10%
  • Family history of aortic disease: 10%
  • Familial thoracic aortic aneurysm: 5%
• Aortopathy was not recognized until after aortic dissection in 47% of the women
• 97% of women survived aortic dissection hospitalization

CONCLUSION:

• Aortic dissection with pregnancy is rare
• Most patients had an underlying aortopathy and in approximately half of these cases, diagnosis was not established until after dissection  
• Type A dissections were associated with a dilated aorta, while type B were not
• The authors conclude

Recognizing women with predisposition to aortic dissection, counseling them before conception, and monitoring the aorta throughout pregnancy may lessen the risk of this rare complication of pregnancy and improve outcomes

Learn More – Primary Sources:

Clinical Features and Outcomes of Pregnancy-Related Acute Aortic Dissection

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