Clinical and laboratory characteristics
The clinical and laboratory characteristics of patients are summarized in Table 1. All patients had complicated TBAD. The age range of the patients was 27 to 44 years, and the range of gestational weeks at admission was 27 weeks plus three days to 36 weeks plus six days. Among these patients, none of them had diabetes, chronic hypertension, connective tissue disorder, or cardiovascular disease before pregnancy. However, three patients developed pre-eclampsia during pregnancy. In addition, all patients were multipara and had a history of cesarean section. All five patients presented with severe chest pain and/or back pain. Since the occurrence of thoracic back pain, three patients showed elevated blood pressure, and two of them had refractory hypertension. All patient has asymmetric blood pressure. Only one patient had a cardiac function rating of Ⅲ, while the other three patients had a cardiac function rating of Ⅱ. Additionally, one patient had signs of threatened premature delivery, including uterine contraction and cervical shortening.
All five patients had a CTA test after admission and showed typical signs of complicated TBAD (Figure 1). Three patients’ lesions were evaluated from the aortic arch. In contrast, the lesion formation of another two patients started distal to the left subclavian artery. Three patients had imaging evidence of malperfusion, mainly manifested as extensive arterial involvement, including the renal artery, celiac trunk, and superior mesenteric artery. The range of aortic width was 18.57-31.35mm. One patient’s cardiac ultrasound showed aortic regurgitation and aneurysmal dilatation of the aortic sinus. Data from laboratory tests showed that four of the five patients had elevated level of D-Dimer, with an average of (719 ± 243.79) ng/L. Four patients had increased lymphocyte ratio (mean value: 86.74 % ± 7.22%), three of which had elevated white blood-cell counts (mean value 13.54 ± 4.54×109/L). Pro-BNP and myocardial enzymes were in the normal range in all patients.