Successful treatment of a gravida with acute type A aortic dissection in the third trimester: A case report

Rationale:Acute type A aortic dissection is a rare and catastrophic complication of pregnancy with a very high mortality rate for both the mother and the fetus. Patient concerns:A 40-year-old female who was 31 weeks pregnant was transferred to our hospital due to "chest and back pain for 7 hours." Enhanced computed tomography (CT) of the aorta revealed a Standford A dissection, involving 3 branches of the aortic arch and the opening of the right coronary artery. The aortic root and ascending aorta were significantly widened. Diagnoses:Acute type A aortic dissection. Interventions:After multidisciplinary discussions, we decided to perform cesarean section first and then cardiac surgery. A live male infant was delivered successfully by Obstetrician and Gynecologist. And then, we performed the Betalls procedure with the use of a mechanical 23# aortic-valve vessel for the patient. The innominate artery openings were reinforced with felt pads. Outcomes:The procedure was successful. CT examination at 2 months after operation showed that the true lumen of the aorta was enlarged, and no dissection was found in the 3 branches of the aortic arch. Lessons:Type A aortic dissection during pregnancy is a rare event that carries a high risk of death for both mother and fetus. An optimal outcome can be achieved through early and accurate diagnosis, safe imaging techniques, timely and effective multidisciplinary discussion, and precise and individualized treatment.