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Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report

Type A aortic dissection is rare in young females; however, it is associated with a high mortality rate. This case report describes a 30-year-old female at 38 weeks of gestation who presented with acute onset chest pain and hypotension responsive to intravenous fluid therapy. Transthoracic echocardi...

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Detalles Bibliográficos
Autores principales: Lin, Cory Y, Stiles, Chelsea L, Subramani, Sudhakar, Maxwell, Matthew J, Peacher, Dionne F, Larson, Sharon B, Hanada, Satoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9684002/
https://www.ncbi.nlm.nih.gov/pubmed/36439601
http://dx.doi.org/10.7759/cureus.30647
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author Lin, Cory Y
Stiles, Chelsea L
Subramani, Sudhakar
Maxwell, Matthew J
Peacher, Dionne F
Larson, Sharon B
Hanada, Satoshi
author_facet Lin, Cory Y
Stiles, Chelsea L
Subramani, Sudhakar
Maxwell, Matthew J
Peacher, Dionne F
Larson, Sharon B
Hanada, Satoshi
author_sort Lin, Cory Y
collection PubMed
description Type A aortic dissection is rare in young females; however, it is associated with a high mortality rate. This case report describes a 30-year-old female at 38 weeks of gestation who presented with acute onset chest pain and hypotension responsive to intravenous fluid therapy. Transthoracic echocardiogram and chest computed tomography angiography confirmed a type A aortic dissection. The patient was transported urgently to the operating room for a Cesarean section and aortic dissection repair. Following induction of general anesthesia, the baby was delivered, oxytocin infusion was started, and a Bakri balloon was placed in the uterus. On cardiopulmonary bypass with circulatory arrest, the ascending aorta and aortic valve were repaired. Multiple uterotonic agents were required intraoperatively to manage persistent uterine bleeding in the setting of full heparinization. Both mother and baby survived without major complications. Preoperative management should focus on maternal hemodynamic control while completing a diagnostic evaluation. Intraoperative considerations include minimizing fetal exposure to medication, maintaining hemodynamic stability, and managing intraoperative blood loss in the setting of full anticoagulation.
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spelling pubmed-96840022022-11-25 Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report Lin, Cory Y Stiles, Chelsea L Subramani, Sudhakar Maxwell, Matthew J Peacher, Dionne F Larson, Sharon B Hanada, Satoshi Cureus Anesthesiology Type A aortic dissection is rare in young females; however, it is associated with a high mortality rate. This case report describes a 30-year-old female at 38 weeks of gestation who presented with acute onset chest pain and hypotension responsive to intravenous fluid therapy. Transthoracic echocardiogram and chest computed tomography angiography confirmed a type A aortic dissection. The patient was transported urgently to the operating room for a Cesarean section and aortic dissection repair. Following induction of general anesthesia, the baby was delivered, oxytocin infusion was started, and a Bakri balloon was placed in the uterus. On cardiopulmonary bypass with circulatory arrest, the ascending aorta and aortic valve were repaired. Multiple uterotonic agents were required intraoperatively to manage persistent uterine bleeding in the setting of full heparinization. Both mother and baby survived without major complications. Preoperative management should focus on maternal hemodynamic control while completing a diagnostic evaluation. Intraoperative considerations include minimizing fetal exposure to medication, maintaining hemodynamic stability, and managing intraoperative blood loss in the setting of full anticoagulation. Cureus 2022-10-24 /pmc/articles/PMC9684002/ /pubmed/36439601 http://dx.doi.org/10.7759/cureus.30647 Text en Copyright © 2022, Lin et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Anesthesiology
Lin, Cory Y
Stiles, Chelsea L
Subramani, Sudhakar
Maxwell, Matthew J
Peacher, Dionne F
Larson, Sharon B
Hanada, Satoshi
Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report
title Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report
title_full Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report
title_fullStr Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report
title_full_unstemmed Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report
title_short Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report
title_sort challenges for emergent combined cesarean delivery and type a aortic dissection repair including bleeding management in the setting of full heparinization: a case report
topic Anesthesiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9684002/
https://www.ncbi.nlm.nih.gov/pubmed/36439601
http://dx.doi.org/10.7759/cureus.30647
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