Atypický průběh disekce hrudní aorty typu A u těhotné ženy

Atypical course of type A thoracic aortal dissection in a pregnant woman

Aortal dissection is an emergency and life endangering incident. It is a longitudinal discission of the arterial wall where blood is coming and creates a haematoma and as a result of that the arteria arches outwards. There is created a double lumen – a proper one and a false one. It is established mostly on the basis of congenital inferiority of the media. In the period of gravidity the disease is mostly manifested in the 3rd trimester and in early puerperium. In our case it was a 34 years old ill woman who was in her 22nd week of gravidity. During her first gravidity there was found hypertension, gestational diabetes and preeclampsia. Due to hypertension she was cured with metropol. At present she has been admitted because of a very intensive pain on the chest and breathing problems. According to TTE there was found a strong aortal regurgitation and a small pericardial exudate. With a suspect dissecting aneurysm of the thoracic aorta she was sent to the coronary unit of the internal clinic. Within a 5-day stay here the aortal dissection (TTE, TEE, spiral CT) was not proved and in the end, the patient was removed to the gynecological obstetric clinic. Suddenly, the eighth day of her hospitalization a consciousness disorder with hypertension and bradycardia appeared. She was sent back to the coronary unit mentioned above. After some examinations there was revealed a clear acute dissection of the ascending aorta (TEE, angio CT) and was turned over to a cardiosurgical intervention. After the previous section she was given Bentall operation (substitution of aortal valve and ascending aorta). In the early postoperative period she was cured with a combined hypotension medication. On the 6th postoperative day on CT of the abdomen she was found with a tumor in her left kidney and was indicated left-sided nephrectomy. Lifelong anticoagulant therapy was indicated. On the 21st postoperative day she was sent back to the gynecological clinic and after a week she was discharged from hospital in good condition. When dismissed she was cured with metropol and warfarin. Our case report shows an atypical example of thoracic aorta dissection in the gravidity period with a postponed diagnosis and a successful cardiosurgical intervention.

Key words:
aortal dissection – pregnancy – thoracic aorta – hypertension – Bentall operation – renal tumor.