Thoracic Aortic Dissection (Type B) Managed with Emergency Cesarean Section and Thoracic Endovascular Aortic Repair.

Abstract

BACKGROUND Type B aortic dissection occurring after labor can be life-threatening. Severe hypertension is among the main risk factors. This report highlights the role of early intervention and special monitoring of pregnant women, and their effects on symptoms. CASE REPORT A 28-year-old women with a history of hypertension was admitted to the obstetrics hospital. Two attempts at labor induction were unsuccessful. A decision was made to proceed with a cesarean section. Due to the patient's deteriorating condition, 2 laparotomies were performed, 1 at the initial hospital and another after transfer. Postoperatively, she required intensive care monitoring. Based on imaging studies, a diagnosis of type B thoracoabdominal aortic dissection complicated by malperfusion was established. Endovascular aortic repair involved placement of an aortic stent graft under imaging guidance. A Zenith TX2 Dissection endovascular stent graft with a Pro Form Z-Track Plus delivery system was introduced. Afterward, the patient underwent 2 more surgeries: duodenum resection and creation of a gastro-descending colon anastomosis. Upon hospital admission, the patient was in very serious general condition. However, after 2 months of treatment and improvement, she was discharged. CONCLUSIONS This report demonstrates that hypertension during pregnancy, combined with unsuccessful attempts at delivery, may be a significant risk factor for aortic dissection. Effective diagnosis and management of these patients is challenging and requires multidisciplinary care, including the use of computed tomography with contrast as soon as possible due to its higher benefits, and the immediate endovascular approach as the safest method of treating postpartum aortic dissection.