TEVAR for acute type B aortic dissection in pregnant women (35 weeks gestation) with Takayasu's arteritis after cesarean section: a rare case report and literature review
BackgroundTakayasu's arteritis (TA) is an autoimmune disease that invades large arteries and mostly occurs in women of childbearing age. It leads to thickening and loss of elasticity of the arterial wall, and eventually vascular occlusion, aneurysm or dissection formation. Type B aortic dissect...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1498914/full |
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| author | Taiyu Bi Xiaotian Duan Yipeng Yin |
| author_facet | Taiyu Bi Xiaotian Duan Yipeng Yin |
| author_sort | Taiyu Bi |
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| description | BackgroundTakayasu's arteritis (TA) is an autoimmune disease that invades large arteries and mostly occurs in women of childbearing age. It leads to thickening and loss of elasticity of the arterial wall, and eventually vascular occlusion, aneurysm or dissection formation. Type B aortic dissection (TBAD) during pregnancy is a rare disease, which is mostly caused by the increase of blood volume in circulation during pregnancy, the effect of estrogen and progesterone on the aorta, or congenital diseases. TBAD in TA pregnant women is very rare, and the condition is often complicated. It is necessary to make a multidisciplinary treatment plan and determine the timing and method of operation to save the life of mother and fetus.Case descriptionWe report a pregnant woman at 35 weeks of gestation who presented to the emergency department with sudden and continuously unrelieved chest pain. She had TA for five years. Thoracoabdominal aortic computed tomography with angiography (CTA) showed acute TBAD. Her blood pressure was 209/73 mmHg and could not be lowered with Urapidil, therefore she was diagnosed with complex Stanford type B aortic dissection. She underwent cesarean section under general anesthesia, and the tracheal tube was not removed after surgery. Thoracic endovascular aortic repair (TEVAR) was administered under anesthesia 8 h after cesarean section. Intraoperative aortography showed that the stent blocked the tear of the intima of the aorta, and the false cavity was reduced. Her blood pressure was reduced to the normal range (140/90 mmHg or less), and the baby's vital signs were stable. They were discharged five days later. Use steroids to control TA throughout treatment. One year after the operation, the mother was healthy and the baby developed well.ConclusionEarly identification and accurate diagnosis should be made for acute TBAD in late pregnancy. Under the premise of stable hemodynamics, the fetus is delivered by cesarean section first and then TEVAR is the preferred treatment. The diagnosis and treatment plan of AD during pregnancy should be developed and implemented by multiple disciplines according to the vital signs of mother and fetus. TA pregnant women should take steroids during pregnancy, closely detect inflammatory indicators, and avoid pathogenic microbial infection, inflammatory state and complications. At the same time, the necessary follow-up is also the key to ensure the treatment effect. |
| format | Article |
| id | doaj-art-784af501a7d241ca84ba682be1cac765 |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-784af501a7d241ca84ba682be1cac7652025-01-17T06:51:04ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-01-011110.3389/fcvm.2024.14989141498914TEVAR for acute type B aortic dissection in pregnant women (35 weeks gestation) with Takayasu's arteritis after cesarean section: a rare case report and literature reviewTaiyu Bi0Xiaotian Duan1Yipeng Yin2Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun, Jilin Province, ChinaNursing Apartment, First Affiliated Hospital of Jilin University, Changchun, Jilin Province, ChinaThoracic Surgery, First Affiliated Hospital of Jilin University, Changchun, Jilin Province, ChinaBackgroundTakayasu's arteritis (TA) is an autoimmune disease that invades large arteries and mostly occurs in women of childbearing age. It leads to thickening and loss of elasticity of the arterial wall, and eventually vascular occlusion, aneurysm or dissection formation. Type B aortic dissection (TBAD) during pregnancy is a rare disease, which is mostly caused by the increase of blood volume in circulation during pregnancy, the effect of estrogen and progesterone on the aorta, or congenital diseases. TBAD in TA pregnant women is very rare, and the condition is often complicated. It is necessary to make a multidisciplinary treatment plan and determine the timing and method of operation to save the life of mother and fetus.Case descriptionWe report a pregnant woman at 35 weeks of gestation who presented to the emergency department with sudden and continuously unrelieved chest pain. She had TA for five years. Thoracoabdominal aortic computed tomography with angiography (CTA) showed acute TBAD. Her blood pressure was 209/73 mmHg and could not be lowered with Urapidil, therefore she was diagnosed with complex Stanford type B aortic dissection. She underwent cesarean section under general anesthesia, and the tracheal tube was not removed after surgery. Thoracic endovascular aortic repair (TEVAR) was administered under anesthesia 8 h after cesarean section. Intraoperative aortography showed that the stent blocked the tear of the intima of the aorta, and the false cavity was reduced. Her blood pressure was reduced to the normal range (140/90 mmHg or less), and the baby's vital signs were stable. They were discharged five days later. Use steroids to control TA throughout treatment. One year after the operation, the mother was healthy and the baby developed well.ConclusionEarly identification and accurate diagnosis should be made for acute TBAD in late pregnancy. Under the premise of stable hemodynamics, the fetus is delivered by cesarean section first and then TEVAR is the preferred treatment. The diagnosis and treatment plan of AD during pregnancy should be developed and implemented by multiple disciplines according to the vital signs of mother and fetus. TA pregnant women should take steroids during pregnancy, closely detect inflammatory indicators, and avoid pathogenic microbial infection, inflammatory state and complications. At the same time, the necessary follow-up is also the key to ensure the treatment effect.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1498914/fullpregnancytype B aortic dissectionthoracic endovascular aortic repairTakayasu's arteritiscase report |
| spellingShingle | Taiyu Bi Xiaotian Duan Yipeng Yin TEVAR for acute type B aortic dissection in pregnant women (35 weeks gestation) with Takayasu's arteritis after cesarean section: a rare case report and literature review Frontiers in Cardiovascular Medicine pregnancy type B aortic dissection thoracic endovascular aortic repair Takayasu's arteritis case report |
| title | TEVAR for acute type B aortic dissection in pregnant women (35 weeks gestation) with Takayasu's arteritis after cesarean section: a rare case report and literature review |
| title_full | TEVAR for acute type B aortic dissection in pregnant women (35 weeks gestation) with Takayasu's arteritis after cesarean section: a rare case report and literature review |
| title_fullStr | TEVAR for acute type B aortic dissection in pregnant women (35 weeks gestation) with Takayasu's arteritis after cesarean section: a rare case report and literature review |
| title_full_unstemmed | TEVAR for acute type B aortic dissection in pregnant women (35 weeks gestation) with Takayasu's arteritis after cesarean section: a rare case report and literature review |
| title_short | TEVAR for acute type B aortic dissection in pregnant women (35 weeks gestation) with Takayasu's arteritis after cesarean section: a rare case report and literature review |
| title_sort | tevar for acute type b aortic dissection in pregnant women 35 weeks gestation with takayasu s arteritis after cesarean section a rare case report and literature review |
| topic | pregnancy type B aortic dissection thoracic endovascular aortic repair Takayasu's arteritis case report |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1498914/full |
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