中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

妊娠合并主动脉夹层

查看全文

妊娠合并主动脉夹层在临床中较少见,同时由于其临床表现特异性小,早期诊断困难,病情进展迅速,孕妇及胎儿死亡率高,妊娠孕妇发生死亡一半是由于发生主动脉夹层。在医疗条件快速发展的今天,妊娠合并主动脉夹层对患者和临床医生仍然是一项巨大挑战,也是产科发生医疗纠纷的重要疾病之一。本文结合近年来发表的相关妊娠合并主动脉夹层的文献,总结妊娠合并主动脉夹层的流行病学特点及相关处理建议。

Aortic dissection during pregnancy is rare in clinic, because the symptoms are lack of specificity, early diagnosis could be difficult. However, the progression of aortic dissection is fast, therefore, the mortality of pregnant women and fetuses is high, the half of death in pregnant women is due to aortic dissection. Although the development of medical condition is rapid, aortic dissection of pregnancy is still a great challenge for patients and clinicians, and is one of the most important diseases in obstetric medical disputes. In this paper, which combined with the literatures published in recent years, we summarized the epidemiological characteristics and related treatment suggestions of the aortic dissection in pregnancy.

关键词: 主动脉夹层; 妊娠;  

Key words: Pregnancy; Marfan syndrome; aortic dissection

1. Westhoff-Bleck M, Podewski E, Hilfiker A, et al. Cardiovascular disorders in pregnancy: diagnosis and management. Best Pract Res Clin Obstet Gynaecol, 2013, 27(6): 821-834.
2. Liu YY, Li HY, Jiang WJ, et al. Treatment of patients with aortic disease during pregnancy and after delivery. J Int Med Res, 2017, 45(4): 1359-1368.
3. Thalmann M, Sodeck GH, Domanovits H, et al. Acute type A aortic dissection and pregnancy: a population-based study. Eur J Cardiothorac Surg, 2011, 39(6): e159-e163.
4. Kamel H, Roman MJ, Pitcher A. Pregnancy and the risk of aortic dissection or rupture: a cohort-crossover analysis. Circulation, 2016, 134(7): 527-533.
5. Immer FF, Bansi AG, Immer-Bansi AS, et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Ann Thorac Surg, 2003, 76(1): 309-314.
6. Yang G, Peng W, Zhao Q, et al. Aortic dissection in women during the course of pregnancy or puerperium: a report of 11 cases in central south China. Int J Clin Exp Med, 2015, 8(7): 11607-11612.
7. Yuan SM. Aortic dissection during pregnancy: a difficult clinical scenario. Clin Cardiol, 2013, 36(10): 576-584.
8. Omnes S, Jondeau G, Detaint D, et al. Pregnancy outcomes among women with Marfan syndrome. Int J Gynaecol Obstet, 2013, 122(3): 219-223.
9. Finkelmeier BA, Marolda D. Aortic dissection. J Cardiovasc Nurs, 2001, 15(4): 15-24.
10. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
11. Shihata M, Pretorius V, MacArthur R. Repair of an acute type A aortic dissection combined with an emergency cesarean section in a pregnant woman. Interact Cardiovasc Thorac Surg, 2008, 7(5): 938-940.
12. Olsson C, Thelin S, Ståhle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation, 2006, 114(24): 2611-2618.
13. Chang CY, Yang JM, Lam CW, et al. Successful management of aortic dissection in a patient with Marfan syndrome during pregnancy. Am J Obstet Gynecol, 2013, 208(2): e3-e6.
14. Lichtman AD, Kjaer K. Combined cesarean delivery and repair of acute ascending and aortic arch dissection at 32 weeks of pregnancy. J Cardiothorac Vasc Anesth, 2013, 27(4): 731-734.
15. Goland S, Elkayam U. Pregnancy and Marfan syndrome. Ann Cardiothorac Surg, 2017, 6(6): 642-653.
16. Roman MJ, Pugh NL, Hendershot TP, et al. Aortic Complications Associated With Pregnancy in Marfan Syndrome: The NHLBI National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). J Am Heart Assoc, 2016, 5(8): pii: e004052.
17. European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(24): 3147-3197.
18.