Introduction
Aortic dissection (AD) in pregnancy is a rare and life-threatening
complication. Data from the International Registry of Acute Aortic
Dissection showed that aortic dissection in pregnancy accounts for
0.0004% of all pregnancies, and 0.1% to 0.4% of all aortic
dissection1. Although, it was reported that pregnancy
with type B aortic dissection (TBAD) accounts for 11% to 21% of this
disease2. The incidence of TBAD during pregnancy and
puerperium rose from 2002 to 2017 based on the data from the National
Inpatient Sample (NIS) database of the United States3.
Moreover, it was surprising that the hospital mortality of TBAD group
was higher than that of type A AD (TAAD) group. In addition, it was
reported that fetal outcomes were worse in TBAD group due to possible
involvement of the iliac arteries4. Despite the
elevated incidence and serious hazard of pregnant with TBAD, the optimal
management strategy for this disease remains controversial and
undetermined.
For TBAD in pregnancy, current treatment experience is still
insufficient and primarily based on case reports and small case series.
TBAD can be divided into complicated and uncomplicated according to
clinical features and disease severity. Uncomplicated TBAD in is usually
recommended to be treated medically, while complicated TBAD is
preferably treated with thoracic endovascular aortic repair (TEVAR). The
success rate of TEVAR for TBAD in unpregnant people was reported as high
as 97.66% to 99.20%5. However, its effectiveness and
safety in TBAD in pregnancy remains uncertain especially taken fetus
life into consideration in late gestation. Therefore, it is necessary to
explore the optimal treatment strategy for patients with TBAD in late
pregnancy. This article summarized the data of five cases with
complicated TBAD in late pregnancy at our center and analyzed the
corresponding maternal and fetal outcomes. The aim of this study is to
investigate an optimal management strategy of pregnant with complicated
type B aortic dissection during the late second or third trimesters.