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Management of a Parturient with an Aortic Pseudoaneurysm

Published:October 12, 2022DOI:https://doi.org/10.1053/j.jvca.2022.10.011
      CARDIOVASCULAR DISEASE is a leading cause of mortality during pregnancy in the United States.
      • Elkayam U
      • Goland S
      • Pieper PG
      • et al.
      High-risk cardiac disease in pregnancy: Part I.
      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.
      • Kamel H
      • Roman MJ
      • Pitcher A
      • et al.
      Pregnancy and the risk of aortic dissection or rupture: A cohort-crossover analysis.
      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.

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