Ann Thorac Surg 2009;87:1962. doi:10.1016/j.athoracsur.2008.09.018
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Unexpected Finding During Pregnancy
Ricardo R. Dias, MD, PhDa,*,
Omar A.V. Mejia, MDa,
Alfredo I. Fiorelli, MD, PhDa,
Pablo M.A. Pomerantzeff, MD, PhDa,
Charles Mady, MD, PhDb,
Noedir A.G. Stolf, MD, PhDa
a Department of Cardiovascular Surgery, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
b Department of Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
* Address correspondence to Dr Dias, R. Eneas de Carvalho Aguiar, 44 - 2° andar - sala 13 bloco 2, Sao Paulo, 05403-000, Brazil (Email: diasrr{at}hotmail.com).
A previously healthy 42-year-old woman was admitted to our hospital. She was asymptomatic in her first 33 weeks' gestation and had neither prenatal follow-up nor a history of hypertension, nor a gestational one. A chest roentgenogram brought by the patient revealed mediastinal enlargement. However, she reported a negative history of chest pain and a transthoracic echocardiogram showed mild aortic regurgitation but no pericardium effusion. In addition, she had no evidence of any connective tissue disorder. The magnetic resonance image showed a typical aspect of type I aortic dissection with a 60-mm ascending aorta diameter and an enlarged uterus containing the developing fetus (Fig 1). A diagnosis of chronic type I dissection was made. The patient was kept hospitalized, and in week 36 of gestation she gave birth to a healthy boy through a Cesarean section (Apgar 9, 10, 10). After the puerperium, she underwent ascending and hemi-arch replacement and aortic valve re-suspension. The proximal aortic findings were normal valve leaflets, normal sized sinuses, and an intimal thickening with a tear not extending within the sinuses proper. Furthermore, the residual dissected arch seen through the open hemi-arch reconstruction showed no additional tear or enlargement. The patient was discharged from the hospital on postoperative day 6, and at their 6-month follow-up, both mother and baby were in good condition.
