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Ann Thorac Surg 1998;65:1511-1512
© 1998 The Society of Thoracic Surgeons

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Correspondence

Aortic Dissection During Pregnancy

^a Division of Cardiology, Department of Medicine, George Washington University Medical Center, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA

Aortic dissections predominate in male patients, with a male-to-female ratio of 3:1, but there is a clear association with pregnancy, as was pointed out by Zeebregts and associates [1]. Half of all dissections in women under the age of 40 years occur during pregnancy, usually in the third trimester [1, 2]. It is well known that the systemic blood pressure and blood volume rise during late pregnancy. Furthermore, the alterations in the structure of the aortic wall during pregnancy have been reported to be very similar to the patterns of medial degeneration found in patients with aortic dissection [3]. Therefore, from both hemodynamic and anatomic standpoints, it is reasonable to believe that aortic dissection would be more frequent during pregnancy than during nonpregnant periods.

Although type A aortic dissection is a surgical emergency, type B aortic dissection, which is rare during pregnancy [1], is usually treated medically [1, 2]. Medical treatment consists of a combination of sodium nitroprusside and a ß-blocker. Although Zeebregts and associates [1] cautioned against the use of nitroprusside during gestation because of fetal cyanide poisoning, I would like to add a note of caution regarding the use of ß-blockers during pregnancy [4].

ß-Blockers, both cardioselective and noncardioselective, have important maternal and fetal side effects. For example, they can increase the uterine tone and contractility and decrease umbilical blood flow [5]. Therefore, ß-blockers should be used cautiously in the lowest possible dose, especially during the last phase of pregnancy, and their use should be discontinued before labor because of their effects on the uterus and to prevent neonatal complications. Furthermore, propranolol also has a possible teratogenic effect [5].

References

1. Zeebregts C.J., Schepens M.A., Hameeteman T.M., Morshuis W.J., Brutel de la Rivière A. Acute aortic dissection complicating pregnancy. Ann Thorac Surg 1997;64:1345-1348.[Abstract/Free Full Text]
2. Cheng T.O. Severe, radiating chest pain in a hypertensive man. Cortlandt Forum 1998;11(2):185-196.
3. Anderson R.A., Fineron P.W. Aortic dissection in pregnancy: importance of pregnancy-induced changes in the vessel wall and bicuspid aortic valve in pathogenesis. Br J Obstet Gynaecol 1994;101:1085-1088.[Medline]
4. Cheng T.O. Caution in use of beta blockers during pregnancy. Cathet Cardiovasc Diagn 1995;34:186.
5. Cheng T.O. The international textbook of cardiology. New York: Pergamon Press, 1987:1028.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cheng, T. O. Search for Related Content PubMed PubMed Citation Articles by Cheng, T. O.