Type B Aortic Dissection (TBAD) occurs seldomly in pregnancy, but has disastrous consequences for both mother and fetus. The focus of immediate surgical repair of Type A Aortic Dissection due to higher mortality of patients is less clear in its counterpart, TBAD, in which management is controversial and debated. Risk factors for TBAD include: aortic wall stress due to hypertension, previous cardiac surgery, structural abnormalities (bicuspid aortic valve, aortic coarctation), and connective tissue disorders. In pregnancy, pre-eclampsia is a cause of increased aortic wall stress. Management of this condition is often conservative, but this is dependent on a number of factors, including gestation, cardiovascular stability of the patient, and symptomology. In most cases, a Caesarean section prior to intervention is carried out, unless certain indications are present. Due to a scarce number of cases across decades, it is difficult to determine which management is optimal. This article collates knowledge so far on this rare event during pregnancy.
Type A acute aortic dissection (TAAD) during pregnancy is a life-threatening event for both the mother and unborn baby. Pregnancy has been recognised as an independent risk factor for TAAD, postulated to be due to physiological changes that cause hyperdynamic circulation. Presentation can be atypical in many cases and further concern from clinicians of fetal radiation exposure can result in missed or delayed diagnoses. Investigation via quickest form of imaging, whether CT, MRI or transoesophageal echocardiography, should be carried out promptly due to the high risk of mortality. Surgical management of TAAD in pregnancy revolves primarily around the decision to deliver the foetus concomitantly or to perform aortic repair with the foetus in utero. This review will summarise the difficulties faced when managing TAAD in pregnancy, and important questions for future research.