Aortic dissection a rare complication of pregnancy with aortopathy conditions: JAMA

Aortic dissection is a rare, life-threatening complication of pregnancy. Women with significant aortic dilatation are advised to avoid pregnancy or undergo prophylactic aortic aneurysm surgery before conception. Multidisciplinary preconception counseling in at-risk women involves shared decision-making to discuss risks (including aortic dissection) and advise on optimal management, as well as when pregnancy is best avoided. However, many women with pregnancy-related aortic dissection are not recognized beforehand to be at risk.

In this recent study , Researchers examined the clinical features, aortic imaging characteristics, and outcomes of women with acute aortic dissection related to pregnancy listed in the International Registry of Acute Aortic Dissection (IRAD).

it was adesigned  cohort study, comprising data from the International Registry of Acute Aortic Dissection (IRAD) (February 1, 1998, to February 28, 2018). The multicenter referral center study included 29 women with aortic dissection during pregnancy or less than 12 weeks post partum in IRAD from 1998 to 2018. The primary outcome assessed was clinical features of pregnancy-related aortic dissection to be studied included underlying aortopathy, aortic size, type of aortic dissection, timing of dissection, hypertension, and previous aortic surgery.

On analysis, results revealed the following facts.

• A total of 29 women (mean [SD] age, 32 [6] years) had pregnancy-related aortic dissection, representing 0.3% of all aortic dissections and 1% of aortic dissection in women in the IRAD. Among women younger than 35 years, aortic dissection was related to pregnancy in 20 of 105 women (19%).
• Thirteen women (45%) had type A aortic dissection, and 16 women (55%) had type B. Aortic dissection onset was known in 27 women (93%): 15 during pregnancy, 4 in the first trimester, and 11 in the third trimester; 12 were post partum, occurring a mean (SD) of 12.5 (14) days post partum.
• At type A aortic dissection diagnosis, the mean (SD) aortic diameters were sinus of Valsalva, 54.5 (5) mm and ascending aorta, 54.7 (6) mm.
• At type B aortic dissection diagnosis, the mean (SD) descending aortic diameter was 32.5 (5) mm.
• Twenty women (69%) had an aortopathy condition or a positive family history: 13 women (65%) with Marfan syndrome, 2 women (10%) with Loeys-Dietz syndrome, 2 women (10%) with bicuspid aortic valves, 2 women (10%) with a family history of aortic disease, and 1 woman (5%) with familial thoracic aortic aneurysm.
• Aortopathy was not recognized until after aortic dissection in 47% of the women.
• Twenty-eight women (97%) survived aortic dissection hospitalization.

"Aortic dissection complicating pregnancy is rare. Most pregnancy-related aortic dissection is due to an aortopathy often not diagnosed until after aortic dissection. In this study, type A aortic dissections were associated with a dilated aorta, and type B aortic dissections often were not. Recognition of underlying conditions and risks for aortic dissection may improve management of pregnancy in women with aortopathy." said the team.

"This IRAD study represents one of the largest analyses to date of pregnancy-related acute aortic dissection. Our findings document the strong link between underlying aortopathy and aortic dissection related to pregnancy. "the authors concluded.

For full article click on link: doi:10.1001/jamacardio.2020.4876

Primary source: JAMA Cardiology