Emergency ascending aortic replacement for acute type a aortic dissection in a 31-week pregnant patient with Marfan syndrome.
4 affiliations
- 1Rīga Stradiņš University, Riga, Latvia. [email protected].
- 2Department of Surgery, Riga Stradiņš University, Riga, Latvia.
- 3Centre of Cardiac Surgery, Pauls Stradiņš Clinical University Hospital, Riga, Latvia.
- 4Institute of Diagnostic Radiology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia.
Abstract
Background
Acute type A aortic dissection during pregnancy is a rare but life-threatening condition, with an estimated incidence of approximately 4 cases per 1 million women aged 15-45 years. Hormonal and hemodynamic changes during pregnancy are factors that may predispose to aortic dissection. These changes begin in the first and second trimesters but are most pronounced in the third trimester and the early postpartum period. Genetic syndromes, such as Marfan syndrome, significantly increase the risk of aortic dissection.Case presentation
A 41-year-old pregnant woman at 31 weeks of gestation with genetically confirmed Marfan syndrome presented with acute, severe, sharp retrosternal chest pain lasting four hours, radiating to the neck, accompanied by weakness and dizziness. Transthoracic echocardiography revealed dilation of the ascending aorta without significant aortic valve regurgitation. Computed tomography angiography confirmed the diagnosis of Stanford type A aortic dissection. Following a multidisciplinary team decision, an initial cesarean section with subsequent uterine artery embolization was performed, followed by emergency ascending aortic replacement. The patient and the newborn were successfully discharged on postoperative day 20.Conclusions
Although aortic dissection during pregnancy is rare, clinicians must maintain a high suspicion index for pregnant women presenting with severe chest pain. Careful monitoring of patients with suspected or confirmed connective tissue disorders is essential. This case demonstrates that acute type A aortic dissection may occur in pregnant patients with Marfan syndrome despite only moderate aortic root enlargement and highlights the value of rapid multidisciplinary management, including coordinated obstetric, endovascular, and cardiac surgical intervention.
Related
- Situs Inversus Totalis with Mirror-Image Dextrocardia and Acute Type A Aortic Dissection Treated by Ascending Aorta Replacement Plus Total Arch Replacement and Frozen Elephant Trunk Using an Inverted Four-Branched Graft: A Case Report
- Ascending and hemi arch replacement during bilateral orthotopic lung transplant: a case report
- Staged open ascending aortic replacement and endovascular total arch repair using a three-inner-branch physician-modified endograft for chronic postdissection aneurysms.
- A Giant Atherosclerotic Ascending Aortic Aneurysm (13.5 cm) With Arch Involvement Successfully Managed by Valve-Sparing Total Arch Replacement: A Case Report
- Automated Versus Conventional Annular Suturing in Totally Endoscopic Aortic Valve and Ascending Aorta Replacement: A Prospective Randomized Trial
BibTeX
@article{upenieks2026emergency,
title = {{Emergency ascending aortic replacement for acute type a aortic dissection in a 31-week pregnant patient with Marfan syndrome.}},
author = {Krišjānis Upenieks and Kristiāns Meidrops and Ivars Brečs and Andris Veiss},
journal = {Journal of cardiothoracic surgery},
year = {2026},
month = jul,
doi = {10.1186/s13019-026-04575-y},
url = {https://europepmc.org/article/MED/42894227},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Emergency ascending aortic replacement for acute type a aortic dissection in a 31-week pregnant patient with Marfan syndrome.
AU - Krišjānis Upenieks
AU - Kristiāns Meidrops
AU - Ivars Brečs
AU - Andris Veiss
PY - 2026
DA - 2026/07/01
JO - Journal of cardiothoracic surgery
DO - 10.1186/s13019-026-04575-y
UR - https://europepmc.org/article/MED/42894227
AB - Background Acute type A aortic dissection during pregnancy is a rare but life-threatening condition, with an estimated incidence of approximately 4 cases per 1 million women aged 15-45 years. Hormonal and hemodynamic changes during pregnancy are factors that may predispose to aortic dissection. These changes begin in the first and second trimesters but are most pronounced in the third trimester and the early postpartum period. Genetic syndromes, such as Marfan syndrome, significantly increase the risk of aortic dissection.Case presentation A 41-year-old pregnant woman at 31 weeks of gestation with genetically confirmed Marfan syndrome presented with acute, severe, sharp retrosternal chest pain lasting four hours, radiating to the neck, accompanied by weakness and dizziness. Transthoracic echocardiography revealed dilation of the ascending aorta without significant aortic valve regurgitation. Computed tomography angiography confirmed the diagnosis of Stanford type A aortic dissection. Following a multidisciplinary team decision, an initial cesarean section with subsequent uterine artery embolization was performed, followed by emergency ascending aortic replacement. The patient and the newborn were successfully discharged on postoperative day 20.Conclusions Although aortic dissection during pregnancy is rare, clinicians must maintain a high suspicion index for pregnant women presenting with severe chest pain. Careful monitoring of patients with suspected or confirmed connective tissue disorders is essential. This case demonstrates that acute type A aortic dissection may occur in pregnant patients with Marfan syndrome despite only moderate aortic root enlargement and highlights the value of rapid multidisciplinary management, including coordinated obstetric, endovascular, and cardiac surgical intervention.
SN - 1749-8090
ER -