CARDIOVASCULAR DISEASE is a leading cause of mortality during pregnancy in the United
States.
1
One cardiovascular condition, an aortic pseudoaneurysm, has high risk for fatal rupture,
especially when exacerbated by physiologic changes that occur during pregnancy, including
hormonal fluctuations that weaken the aortic wall and reduce its ability to withstand
pregnancy-induced increases in blood volume, heart rate, and cardiac output.
2
Emergent surgical repair of this serious condition is needed to preserve life. Emergent
surgical repair, however, is complicated in patients with multiple previous cardiac
surgeries, as sternal re-entry may breach the ascending aortic pseudoaneurysm and
cause exsanguination. Aortic clamping and myocardial protection strategies are similarly
complicated in this high-risk situation. The authors report a case of a full-term
parturient with a history of 2 prior cardiac surgeries who presented with a rapidly
growing aortic pseudoaneurysm. The authors describe the planned use of minimally invasive
procedures, including an endovascular aortic balloon (endo-balloon) for endo-occlusion
in case of pseudoaneurysm rupture, and a percutaneous coronary sinus catheter to provide
myocardial protection. These efforts facilitated successful pseudoaneurysm repair,
preserving the life of the mother and baby.Key Words
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References
- High-risk cardiac disease in pregnancy: Part I.J Am Coll Cardiol. 2016; 68: 396-410
- Pregnancy and the risk of aortic dissection or rupture: A cohort-crossover analysis.Circulation. 2016; 134: 527-533
- The increase in the rate of maternal deaths related to cardiovascular disease in Japan from 1991-1992 to 2010-2012.J Cardiol. 2017; 69: 74-78
- Outcomes in pregnant women with acute aortic dissections: A review of the literature from 2003 to 2013.Int J Obstet Anesth. 2014; 23: 348-356
- Histopathologic findings in human aortic media associated with pregnancy.Arch Pathol. 1967; 83: 336-341
- Impact of pregnancy on aortic root in women with repaired conotruncal anomalies.Pediatr Cardiol. 2019; 40: 1134-1143
- Angina caused by systolic compression of the left coronary artery as a result of pseudoaneurysm of the mitral-aortic intervalvular fibrosa.Am Heart J. 1995; 129: 417-421
- Unusual cause of acute coronary syndrome: Dynamic coronary compression by an aortic pseudoaneurysm.Eur Heart J Cardiovasc Imaging. 2013; 15: 468-469
- 41 Years after Björk-Shiley valve implantation: Advanced preparation of a giant root pseudoaneurysm entrapping the right coronary artery.Eur J Cardiothorac Surg. 2015; 48: 512-513
- Dual coronary compression: An exceedingly rare complication secondary to annuloaortic ectasia.Ann Thorac Surg. 2020; 109: e153
Greco E, Zaballos JM, Alvarez L, et al. Video-assisted mitral surgery through a micro-access: A safe and reliable reality in the current era. 2008;17:48.
- Safe reentry for false aneurysm operations in high-risk patients.Ann Thorac Surg. 2017; 103: 1907-1913
- Endoaortic occlusion with the intraclude device during the management of ascending aortic pseudoaneurysm.Innovations (Philadelphia, Pa). 2015; 10: 71-72
Article Info
Publication History
Published online: October 12, 2022
Publication stage
In Press Corrected ProofIdentification
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