Key result
A 24-year-old pregnant woman with Marfan's syndrome and acute aortic dissection successfully underwent a Bentall operation 2 days after an emergency cesarean section, with good outcomes for both mother and baby.
Case Report (n=1)
No
A two-stage surgical strategy comprising emergency cesarean section followed by a Bentall operation 2 days later can be safely performed in pregnant patients with Marfan syndrome and acute type A aortic dissection to minimize bleeding risks.
Answers are grounded in this paper and cite their sources.
Staged cesarean-Bentall appears feasible in pregnant Marfan patients with type A dissection; leaves open whether it alters management.
妊娠後期に急性大動脈解離を発症し,緊急帝王切開2日後にBentall手術を行い救命しえたMarfan症候群の1例を経験した.症例は24歳女性,妊娠31週,これまでの妊娠期間中にとくに異常を認めなかったが,突然の胸背部痛にて当院救急受診となった.高身長,クモ状指,リストサイン陽性,視力障害および側弯症を認め,Marfan症候群と診断した.造影CT検査および心エコー検査で大動脈弁輪拡張症を伴うStanford A型急性大動脈解離の発症を認めた.これ以上の妊娠継続は不可能であると判断し,緊急帝王切開術を施行,1,706gの男児を娩出した.造影CTで偽腔灌流を認め,早期血栓閉塞が期待できなかったこと,また大動脈弁閉鎖不全症にて急性心不全を起こしかねないことより,可及的早期の心血管修復が必要であると考えられた.しかし,ヘパリン投与による帝王切開後の子宮・胎盤剥離面からの大量出血を危惧し,二期的手術の方針とした.帝王切開2日後にBentall手術を行い,術中・術後に子宮・胎盤剥離面からの出血に悩まされることもなく,母子ともに良好な結果を得た.
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Inoue et al. (2005) conducted a case report in Marfan's syndrome with acute aortic dissection during pregnancy (n=1). Emergency cesarean section followed by Bentall operation was evaluated on Maternal and fetal survival and surgical success. A 24-year-old pregnant woman with Marfan's syndrome and acute aortic dissection successfully underwent a Bentall operation 2 days after an emergency cesarean section, with good outcomes for both mother and baby.
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