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Aortic Dissection in Pregnancy — EECC MCQ

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HardAortic DiseaseAortic Dissection in PregnancyEECC

A 32-year-old woman with Marfan syndrome at 30 weeks gestation presents with acute tearing chest pain and hypertension. CT aortography (performed with lead shielding) shows a type A aortic dissection with an ascending aortic diameter of 55 mm. What is the recommended management?

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Correct answer: A — Emergency ascending aortic surgery with concurrent caesarean section if the fetus is viable, or cardiopulmonary bypass with fetal monitoring if delivery is not immediately required

Type A aortic dissection in pregnancy is a surgical emergency with the same mortality risk as in non-pregnant patients if untreated. The 2025 ESC CVD in Pregnancy Guidelines and Aortic Disease Guidelines recommend emergency surgery regardless of gestational age. The approach depends on fetal viability: (1) If ≥28-32 weeks (viable fetus), concurrent caesarean section followed by aortic surgery on the same anaesthetic; (2) If <28 weeks, aortic surgery on cardiopulmonary bypass with continuous fetal monitoring (fetal survival rates during CPB are approximately 70-80%). TEVAR has no role in ascending aortic dissection. Marfan syndrome is the most common connective tissue disorder associated with aortic dissection in pregnancy.

Reference: ESC (2025): Guidelines for CVD in Pregnancy; ESC (2024): Aortic Disease Guidelines