A Case of Acute Aortic Dissection with Patent Ductus Arteriosus after the Labor
1Sixth-year Medical Student, Nippon Medical School
2Resident, Nippon Medical School
3Division of Intensive and Coronary Care Unit, Nippon Medical School Hospital
4Department of Female Reproductive and Developmental Medicine, Graduate School of Medicine, Nippon Medical School
Case: A 33-year-old female.
Present history: She delivered a child of 40 weeks' gestational age following an uncomplicated pregnancy and labor. Four days later, she complained of severe epigastralgia, back pain, and pain in the left lower extremity. She was immediately transferred to our Critical Care Unit on suspicion of aortic dissection.
Clinical course: On admission, her blood pressure was 202/94 mmHg (left arm), and her ankle-brachial index was 0.74 (right) and 0.81 (left). Emergency computed tomography examination revealed that the dissection extended from the descending aorta to both common iliac arteries (Stanford B, DeBakey IIIb). In addition, patent ductus arteriosus (PDA) starting at the true lumen of the descending aorta was observed. We started antihypertensive therapy with nicardipine, which gradually controlled her blood pressure and alleviated the ischemia of both lower extremities.
Discussion: Most patients with aortic dissection during pregnancy also have Marfan's syndrome, but no pathognomonic findings indicating this syndrome were present in this case. The possibility of a muscle myosin heavy chain genetic mutation was suggested as the reason for the PDA complication in our patient. We need to be aware of the danger of acute aortic dissection during pregnancy or delivery not only in patients with Marfan's syndrome but also in patients with PDA.
úãåãï 2008; 4(1), 45-49
acute aortic dissection, labor, pregnancy, patent ductus arteriosus
Yoshiya Yamamoto, Sixth-year Medical Student, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan