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中华产科急救电子杂志 ›› 2019, Vol. 08 ›› Issue (02) : 76 -81. doi: 10.3877/cma.j.issn.2095-3259.2019.02.004

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妊娠合并主动脉夹层的诊治
蒋荣珍1, 滕银成1,()   
  1. 1. 200233 上海交通大学附属第六人民医院妇产科,上海市危重孕产妇会诊抢救中心,上海交通大学附属第六人民医院妇产科研究所
  • 收稿日期:2019-02-14 出版日期:2019-05-18
  • 通信作者: 滕银成
  • 基金资助:
    国家自然基(81570444); 上海市卫计委第四轮公共卫生行动计划重点学科建设计划(15GWZK0701); 上海市科技创新行动计划(17411950602)

Diagnosis and treatment of pregnancy with aortic dissection

Rongzhen Jiang1, Yincheng Teng1()   

  • Received:2019-02-14 Published:2019-05-18
  • Corresponding author: Yincheng Teng
引用本文:

蒋荣珍, 滕银成. 妊娠合并主动脉夹层的诊治[J/OL]. 中华产科急救电子杂志, 2019, 08(02): 76-81.

Rongzhen Jiang, Yincheng Teng. Diagnosis and treatment of pregnancy with aortic dissection[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2019, 08(02): 76-81.

妊娠合并主动脉夹层病情凶险,容易误诊、漏诊,母儿不良结局风险极高,且与夹层分型密切相关,病因主要与原发高血压、先天性和遗传性血管性疾病相关,妊娠是其好发因素。胸痛为主要临床表现,诊断主要依靠影像学检查。治疗包括支持治疗、药物治疗、传统手术治疗、主动脉瘤腔内修复术等,治疗方式、分娩时机、分娩方式根据主动脉夹层累及范围与类型、孕周、患者及家属意愿和医疗条件综合决定。加强孕前与孕期保健、多学科评估与救治是降低不良母胎结局的关键。

Pregnancy with aortic dissection is dangerous and easy to be misdiagnosed and to escape diagnosis. The risk of adverse outcomes in mother and child is extremely high, which is closely related to the classification of the dissection. The cause of aortic dissection in pregnancy is mainly related to primary hypertension, congenital and hereditary vascular disease, pregnancy is the risk factor. Chest pain is the main clinical manifestation, and the diagnosis mainly depends on imaging examination. Treatment includes supportive therapy, drug therapy, traditional surgical treatment, thoracic endovascular aneurysm repair, etc. The treatment, timing of delivery and mode of delivery are determined according to the extent and type of aortic dissection, gestational age, patient and family wishes, and medical conditions. Strengthening pre-pregnancy and pregnancy care, multidisciplinary assessment and treatment are the keys to reduce poor outcome of mother and fetus.

[1]
Kamel H, Roman MJ, Pitcher A, Devereux RB. et al. Pregnancy and the risk of aortic dissection or rupture: a Cohort-Crossover Analysis [J]. Circulation, 2016, 134(7): 527-533.
[2]
Zhu JM, Ma WG, Peters S, et al. Dissection in pregnancy: management strategy and outcomes [J]. Ann Thorac Surg, 2017, 103(4): 1199-1206.
[3]
Erbet R, Aboyans V, Boileau C, et al.2014 ESC Guidelines on the diagnosis and treatment of aortic diseases:Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult.The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2014, 35(41): 2873-2926.
[4]
中国医师协会心血管外科分会大血管外科专业委员会,主动脉夹层诊断与治疗规范中国专家共识[J]. 中国胸心血管外科杂志,2017, 33(11): 641-654.
[5]
Velvin G, Wilhelmsen JE, Johansen H, et al. Systematic review of quality of life in persons with hereditary thoracic aortic aneurysm and dissectiondiagnoses [J]. Clin Genet, 2019, 95(6): 661-676.
[6]
Cauldwell M, Steer PJ, Curtis SL, et al. Maternal and fetal outcomes in pregnancies complicated by Marfan syndrome [J]. Heart, 2019 May 25. pii: eartjnl-2019-314817.
[7]
Goland S, Elkayam U.Pregnancy and Marfan syndrome [J]. Ann Cardiothorac Surg, 2017, 6(6): 642-653.
[8]
Al-Thani H, Mekkodathil A, El-Menyar A. Management and Outcomes of Aortic Dissection in Pregnancy with Marfan syndrome: A Systematic Review [J]. Curr Vasc Pharmacol, 2019 Apr 8.
[9]
Seo GH, Kim YM, Kang E, et al. The phenotypic heterogeneity of patients with Marfan-related disorders and their variant spectrums [J]. Medicine (Baltimore), 2018, 97(20): e10767.
[10]
Murray ML, Pepin M, Peterson S, et al. Pregnancy-related deaths and complications in women with Vascular Ehlers-Danlos syndrome [J]. Genet Med, 2014, 16(12): 874-880.
[11]
Frise CJ, Pitcher A, Mackillop L. Loeys-Dietz syndrome and pregnancy:The first ten years [J]. Int J Cardiol, 2017, 226: 21-25.
[12]
Thunström S, Krantz E, Thunström E, et al.Incidence of Aortic Dissection in Turner Syndrome [J]. Circulation, 2019, 139(24): 2802-2804.
[13]
Lensen KD, Voskuyl AE, Comans EF, et al. Extracranial giant cell arteritis: A narrative review [J]. Neth J Med, 2016, 74(5): 182-192.
[14]
Smok DA. Aortopathy in pregnancy [J]. Semin Perinatol, 2014, 38(5): 295-303.
[15]
Guy A, Tiosano S, Comaneshter D, et al. Aortic aneurysm association with SLE – a case–control study [J]. Lupus, 2016, 25(9): 959-963.
[16]
杨贵芳,彭文,赵琴,等. 妊娠合并主动脉夹层临床资料分析[J]. 中国全科医学,2015, 18(14): 1720-1722.
[17]
Silvestri V, Mazzesi G, Mele R. Postpartum aortic dissection. A case report and review of literature [J]. Int J Surg Case Rep, 2019, 56: 101-106.
[18]
Gargotta HR. Type A Aortic Dissection Complicated by Renal and Lower Extremity Malperfusion [J]. Adv Emerg Nurs J, 2019, 41(1): 23-32.
[19]
Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection [J]. J Am Coll Cardiol, 2015, 66: 350-358.
[20]
Liu F, Huang L. Usefulness of ultrasound in the management of aortic dissection [J]. Rev Cardiovasc Med, 2018, 19(3): 103-109.
[21]
European Society of Gynecology, Association for European Paediatric Cardiology, German Society for Gender Medicine, 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) [J]. Eur Heart J, 2011, 32(24): 3147-3197.
[22]
Ong KT, Perdu J, De Backer J, et al. Effect of celiprolol on prevention of cardiovascular events in vascular Ehlers-Danlos syndrome: a prospective randomised, open, blinded-endpoints trial [J]. Lancet, 2010, 376(9751): 1476-1484.
[23]
Chu L, Zhang J, Li YN, et al. Clinical analysis of 24 cases of aortic dissection during pregnancy [J]. Zhonghua Fu Chan Ke Za Zhi, 2017, 52(1): 32-39.
[24]
Chalas BC, Davy C, Marszalek A, et al. Cardiovascular findings in women suffering from Turner syndrome requesting oocyte donation [J]. Hum Reprod, 2011, 26(10): 2754-2762.
[25]
Verscheure D, Haulon S, Tsilimparis N, et al. Endovascular Treatment of Post Type A Chronic Aortic Arch Dissection With a Branched Endograft: Early Results From a Retrospective International Multicenter Study [J]. Ann Surg, 2019 Apr 8. doi: 10.1097/SLA.0000000000003310. [Epub ahead of print]
[26]
Lansman SL, Goldberg JB, Kai M. Aortic surgery in pregnancy [J]. J Thorac Cardiovasc Surg, 2017, 153(2): S44-S48
[27]
Sawlani N, Shroff A, Vidovich MI. Aortic dissection and mortality associated with pregnancy in the United States [J]. J Am Coll Cardiol, 2015, 65(15): 1600-1601.
[28]
Bekkers JA, Raap GB, Takkenberg JJ, et al. Acute type A aortic dissection: long-term results and reoperations [J]. Eur J Cardiothorac Surg, 2013, 43(2): 389-396.
[29]
Umana JP, Lai DT, Mitchell RS, et al. Is medical therapy still the optimal treatment strategy for patients with acute type B aortic dissections? [J]. J Thorac Cardiovasc Surg, 2002, 124(5): 896-910.
[30]
Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, et al; European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM); ESC Committee for Practice Guidelines. 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) [J]. Eur Heart J 2011, 32(24): 3147-3197.
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