Category: AD and Pregnancy

Aortic Disease Proves No Match for a Mother’s Love

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After learning she had an aortic aneurysm and dissection, a mother-to-be faced big risks. Michigan Medicine doctors worked together to keep mom and baby safe.

Last November was the start of a happy time after Monique Lowes learned she was pregnant with her first child. She had struggled for years to conceive and was thrilled at the thought of being a mother.

But her excitement soon turned to fear.

In February, the 37-year-old was advised by her primary obstetrician to undergo an echocardiogram. That screening was due to Lowes’ high blood pressure as well as her age, which put the patient in a high-risk pregnancy category.

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The test revealed a devastating and unexpected diagnosis: a thoracic aortic aneurysm and aortic dissection.

A thoracic aortic aneurysm, also referred to as a TAA, is an enlargement of the first portion of the aorta — the body’s major artery.

An aortic dissection happens when layers of the aorta pull apart and blood becomes trapped between the layers. This weakens the aorta and may cause it to rupture. People who have aortic aneurysms are at higher risk of dissection.

A difficult choice
As in Lowes’ case, the cause of aortic aneurysms isn’t always clear. Risk factors include genetic disorders such as Marfan, Loeys-Dietz or Ehlers-Danlos syndromes, arteriosclerosis (plaque buildup in artery walls) and high blood pressure.

Doctors advised Lowes of the risks that aorta repair surgery could have on her unborn child — as well as the risk she herself might face if the necessary surgery was delayed.

In the end, Lowes chose to delay the surgery.

“As a woman who has struggled with infertility, I wanted to do my best for me and my daughter,” Lowes says, noting that her pregnancy is what revealed the underlying heart condition.

“If it weren’t for her, the aneurysm would never have been discovered in time. It was a miracle that I was pregnant and that I found out about my heart condition.”

Handling with care
Lowes was admitted to Michigan Medicine, where she would spend two months on the fourth floor of the Frankel Cardiovascular Center being observed by a team of specialized providers, including cardiac surgeon Himanshu Patel, M.D., and high-risk obstetrics doctors such as Elizabeth Langen, M.D., of Von Voightlander Women’s Hospital.

“This was a very collaborative effort,” says Patel, noting that Lowes’ doctors worked hand-in-hand to monitor her condition as well as the health of her unborn baby.

SEE ALSO: Lifesaving Facts About Aortic Dissection

The goal: to get Lowes as far along in her pregnancy as possible without compromising her condition.

“The cardiac surgery and OB teams did a great job co-managing her care,” says Langen.

An incubator sat near Lowes’ hospital bed, a constant reminder that the baby might need to be delivered prematurely if the patient’s condition worsened.

But at 28 weeks pregnant, she was finally able to go home before giving birth at 32 weeks to her beautiful daughter, Graysen Faith.

The team’s detailed delivery plan included a cesarean delivery performed at the Frankel Cardiovascular Center, just in case Lowes’ aortic condition required immediate surgery.

“She was born with not a hair on her head out of place,” the proud mother says. “She’s a beautiful baby.”

“Within 24 hours, she was up and able to hold her baby and spend time with her during recovery. It was a successful outcome for her and the baby.”
Himanshu Patel, M.D.
Repair and reflection
Lowes was able to spend time with her newborn at home before returning to the Frankel Cardiovascular Center for surgery in August.

Her open-heart procedure included an incision that enabled access to the weakened area of Lowes’ aorta and dissection. The surgery required her to be put on a heart-lung machine to stop the flow of blood during repair of her aorta.

It didn’t take long, though, for mother-daughter bonding to resume.

“Within 24 hours, she was up and able to hold her baby and spend time with her during recovery,” says Patel. “It was a successful outcome for her and the baby.”

SEE ALSO: Genetic Defect Makes Cardiac Care a Family Affair

“Everyone worked so well with me,” Lowes says of her heart and obstetrics team, including the cardiac and neonatal intensive care nurses. “I fell apart a few times but then found strength to go on.”

She credits her care team as well as her sister, nephew and two nieces for keeping her strong through it all.

It was a risky choice, Lowes now admits, but she’s thankful for the outcome. “I had faith that God had a plan for me and my baby.”

As she recuperates from surgery and cares for her infant daughter, Lowes wants to spread a message of hope to moms faced with similar challenges: “Miracles do happen.”

Breastfeeding Mom Pumping Hours After Open-Heart Surgery Is the Definition of Badass

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Stephanie Sampson is one incredibly lucky mother and she knows it. Not just because she is a mom of three healthy kiddos but because she is here to see just how amazing they are. That’s because Sampson beat the odds and unknowingly gave birth to her youngest, Eli, with an undiagnosed heart condition that in all likelihood, should’ve killed her — especially during labor. But instead, Sampson not only survived childbirth with an aortic aneurysm, this fierce mom was pumping breast milk immediately following open-heart surgery to repair a chronic aortic dissection that few survive. more………………………

Great and fantastic MIRACLE for sure!

Monroe mother meets son 100 days after giving birth, having heart surgery

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CHARLOTTE, N.C. – Doctors and nurses at Carolinas Healthcare System made a bold decision that helped to save the lives of a mother and her unborn son.

Danielle Gaither, 31, was pregnant and went to the emergency department more than three months ago with chest pains caused by a high-risk medical condition.

Doctors said she was minutes away from losing her own life and had a less than one percent chance of surviving in the operating room.

“The gold standard of treating aortic dissection is circulatory arrest, which is a surgical technique that stops blood circulation,” said doctor Jeko Madjarov. “But Danielle’s son needed blood flow in order to survive. This case was extremely rare.”

The team at Carolinas Healthcare System made the call to perform two surgeries at the same time. Doctors delivered her baby and she received emergency open heart surgery. It took a team of more than 15 nurses and doctors and six hours in the operating room.

Gaither’s son, K.V., was born prematurely and is now a healthy baby at home with his family.

Gaither met him for the first time in June, 111 days after he was born.

“It was a miracle that I had my baby,” Gaither said. “I’m glad that I’m here and I thank Dr. Madjarov and the team, along with God, for saving my life.”

Gaither and her family, along with her doctors will be talking about the life-saving surgery Monday afternoon.

She is really quite lucky’: Mom-to-be survives heart condition for 10 days

She is really quite lucky‘: Mom-to-be survives heart condition for 10 days
Today.com
About 50 percent of people with aortic dissection die instantly, said Dr. Richard Shemin, a cardiac surgeon at Ronald Reagan UCLA Medical Center, …

Coming together to save mom and baby

Read this incredible story here:

Very lucky mother gives birth and survive AD surgery

RICHLAND — The miracle of life had a brush with death this week at Kadlec Regional Medical Center when a Richland woman had to have an emergency cesarean section immediately followed by open heart surgery.

Doctors discovered that 31-year-old Ulyana Kuzmycz, who was 35 weeks pregnant, had an aortic dissection, a tear in the inner wall of her aorta that caused blood to flow between the layers, forcing them apart.

The inherited condition is normally an easy fix, said Dr. Hannan Chaugle, a Richland heart surgeon. But when the patient is pregnant, the situation can become life threatening to the mother and child.

Cardiologist Dr. Fadi Alqusi discovered Kuzmycz’s condition Monday morning during a routine visit because the mother-to-be had been having chest pains for a couple weeks.

The couple were aware heart problems ran in her family so they weren’t taken completely by surprise by the news.

“We were monitoring the possibility of this condition,” Kuzmycz said. “But I was feeling so good through most of my pregnancy that we let our guard down.”

But on Sept. 25 everything changed.

“Ulyana was having a splendid pregnancy, not even any nausea,” said her husband Daniel. “Then she started to feel chest pains in her eighth month, and to be on the safe side she began making regular visits to see Dr. Alqusi.”

Within an hour of Alqusi’s diagnosis Monday, Kuzmycz was admitted to Kadlec while a team of six doctors brainstormed how best to proceed. That team also included neotalologists Anthony Hadeed and Miriam Zaragoza, and obstetricians Dr. Kevin Turner and Dr. Kenton Sizemore.

“We needed to save the mom and the baby,” Chaugle said. So the C-section was performed first and 6-pound baby Nina was born, 19.5 inches long, five weeks premature, but otherwise healthy.

Immediately following the birth of her first child, Ulyana Kuzmycz was rushed into an operating room for a seven-hour open heart procedure where Chaugle repaired the aorta.

But the drama didn’t end there.

About 12 hours after the surgery Ulyana’s chest had to be reopened to fix an internal bleeding problem, Daniel Kuzmycz said.

“This was a very risky procedure and everything seems to be OK now. But it wouldn’t have been without this fantastic cardiac unit here at Kadlec. They saved my wife and our baby.”

Ulyana’s mother, Valentina Kurylin from Toronto, a Ukrainian immigrant, also praised the medical team that helped her daughter. “You saved my daughter’s life and I am so grateful,” she told the heart surgeon.

To which Chaugle responded, “I just performed the procedure. It was God who really saved her life.”

The Kuzmyczes were just settling into the Tri-Cities after moving from San Diego about a month ago so Daniel Kuzmycz could work for Pacific Northwest National Laboratories as a psychologist.

Ulyana Kuzmycz’s recovery has been amazing, said Kay Langevin, Kadlec’s cardiac rehab nurse.

“After all she’s been through when she holds her baby while nursing she just glows,” Langevin said.

Ulyana Kuzmycz is hopeful she and her new baby will be able to go home next week. For now, baby Nina remains under the watchful eyes of the Neonatal Intensive Care Unit nurses.

Article Source: http://www.thenewstribune.com/2011/10/15/1865753/richland-woman-has-open-heart.html

Aortic Dissection Rare in Pregnancy With Bicuspid AV

FRIDAY, Jan. 28 (HealthDay News) — Aortic dissection is rare in women with bicuspid aortic valve (BAV) who are pregnant, according to a study published in the January issue of The American Journal of Cardiology.

Stephen H. McKellar, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues searched an echocardiographic database of women who had been diagnosed with congenital BAV between 1980 and 1999. They reviewed medical records for end points of aortic valve replacement (AVR) and aortic dilatation, dissection, or surgery, and conducted a survey to determine obstetric history and further outcome.

The researchers identified 88 women with BAV, with total obstetric histories consisting of 216 pregnancies and 186 deliveries, and no aortic dissections. During a median of 12.3 years of follow-up, 24 patients had AVR, three had ascending aortic surgery, and seven had both. Pregnancy was not related to dilatation of the aorta, aorta surgery, or AVR. At echocardiographic diagnosis of BAV, 6 percent of patients had aortas more than 40 mm in diameter; of 60 patients with comparison echocardiograms at a median of 10.7 years of follow-up, 35 percent had aortas over 40 mm in diameter.

“Pregnancy is, in our view, reasonable to undertake if the aorta is ≤4.5 cm in diameter with rigorous blood pressure control and careful echocardiographic follow-up to identify any progressive aortic enlargement,” the authors write.

The above is the “abstract” and the complete article is found in “The American Journal of Cardiology” which details the results.

Thanks,
Brian Tinsley

Anaesthetic challenges in emergency surgical repair of acute aortic dissection rupturing into the pericardium in a pregnant patient

Abstract: Mohammad Irfan Akhtar,Khalid Samad ( Department of Anaesthesia, Aga Khan University Hospital, Karachi. )

Acute aortic dissection in pregnancy is a serious situation, because rapid and appropriate surgical decision making is required to save the life of both mother and baby. Aortic dissection is rare in young women but is likely during pregnancy (third trimester) secondary to the hyperdynamic and hypervolaemic circulatory state associated with pregnancy.

A 35 years old 27 weeks pregnant patient weighing 90 kg presented in the emergency with severe chest pain. In the immediate post cardiopulmonary bypass period, the patient started bleeding profusely from the anastamotic sites irrespective of utilization of all the conventional methods of haemostasis including multiple units of whole blood, fresh frozen plasma, platelets, calcium and cryoprecipitates.


As a last resort she was given low dose r FVIIa (1.2 mg containing 60 KIU of Factor VII). This stopped the bleeding and the haemodyramics were stabilized.
Keywords: Aortic dissection, pregnant patient, recombinant activated factor VII (r FVII a).

Read entire article here:

Mandy Wyant-37

Name: Mandy Wyant
Email: mandyleigh1969@yahoo.com
Age at time of Dissection: 37
Type of Dissection: Descending

Date of Aortic Dissection: 26 November 1969

Tell Us Your Story:

My story is really hard for me to write but after reading everyone else’s experiences I feel like I should share mine. I was pregnant with twins and on November 22, 2006 they both were delivered without a c-section and I was on top of the world.

They were born only a week away from my due date so I was able to take them home the day after Thanksgiving. My birthday is November 26th so 4 days after they were delivered, I was holding my daughter Jennifer around 4:00am in the morning when this weird burning sensation radiated done my spine and I literally sat up immediately and lost my breath.


When it was over I called for my mother who was staying to help me with the twins. I told  her something just happened and it was not normal. I thought I could not breath right and only felt comfortable on all fours. They called 911 and a policeman arrived and comforted me until the ambulance got there.

The pain was setting in between my two shoulder blades and it was extremely painful. I kept thinking that my epidural had something to do with it because of the way my pain went down my spine in the beginning. I was rushed to Martha Jefferson hospital where my angel Dr. Snufin quickly diagnosed me with an aortic dissection.

From there I was transported to the University of Virginia hospital. Little did I know how serious this was because they did not want to tell me due to anxiety and stress, but they wanted my entire family to come to the hospital because they were afraid I would not make it through the night. This dissection had already killed my left kidney and was working on my right one. I was rushed into surgery and a Radiologist named Dr. Arslen saved my life.

After a week in the hospital I was sent home with tons of medication to keep my Bood Pressure down to prevent complications however I could not stand up without passing out. I could not even take a shower without having a chair to sit in. It was horrible.

Finally I was put on the right dosage of meds so that I was able to somewhat function. It is now going on 4 years since my dissection but my life has been anything but normal I went back to work on a reduced work schedule but could not handle it because I felt like crap all of the time with no energy. I went on disability and applied for Social Security  benefits and was approved rather quickly.

I personally feel impending doom from this experience as I am definitely not the same person. I have been through tremendous bouts with depression and find my life extremely stressful. I believe my husband is in denial and he is not really supportive. I have accepted that this could happen again and I that my life has been shortened  but the only thing that does keep me going are my twin girls.

They are thriving and definitely a handful. I just wish I could be a lot stronger and do the things my girls need from their mother. I could go on and on, but I will end it for now. Thanks for this web site for allowing our personal stories I just wish my story was more happier but it really is not.

Sincerely.

Mandy

Thanks for stopping by to view our stories. Please help me keep the site going by shopping at Amazon.com-It’s very much appreciated. Brian Tinsley founder of AorticDissection.com (please book mark the link once you get to Amazon.com for future purchases!)

Pregnancy complicated by aortic dissection

Here’s and interesting article about AD’s and pregnancy.

Aortic dissection in pregnancy: analysis of risk factors and outcome

Franz F. Immer, MDa*, Anne G. Bansi, MDa, Alexsandra S. Immer-Bansi, MDb, Jane McDougall, MDc, Kenton J. Zehr, MDd, Hartzell V. Schaff, MDd, Thierry P. Carrel, MDa

a Department of Cardiovascular Surgery, Berne, Switzerland
b Institute of Anesthesiology, Berne, Switzerland
c Division of Neonatology, University Hospital, Berne, Switzerland
d Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA

* Address reprint requests to Dr Immer, Department of Cardiovascular Surgery, University Hospital, 3010 Berne, Switzerland
e-mail: franzimmer@yahoo.de

Aortic dissection during pregnancy is a life-threatening event. Recent studies have revealed similar histologic changes in the wall of the ascending aorta in patients with bicuspid aortic valve disease (BAVD). Based on a review of the literature, including the experience from two institutions, we looked at the patient’s characteristics in patients with thoracic aortic dissection during pregnancy. We found that aortic root enlargement (> 4cm) or an increase of aortic root size during pregnancy in patients with BAVD, and Marfan syndrome is associated with a considerable risk for the occurrence of Type A dissection.

Original Articles: General Thoracic

Acute Aortic Dissection Complicating Pregnancy

Clark J. Zeebregts, MD, Marc A. Schepens, MD, PhD, Ton M. Hameeteman, MD, PhD, Wim J. Morshuis, MD, PhD, Aart Brutel de la Rivière, MD, PhD

Departments of Cardiopulmonary Surgery and Gynecology and Obstetrics, St. Antonius Hospital, Nieuwegein, the Netherlands

Accepted for publication May 23, 1997.

Background. Acute aortic dissection occurring during pregnancy represents a lethal risk to both the mother and fetus. Our purpose was to study the prevalence, treatments, and outcome of this rare problem and to suggest therapeutic guidelines.

Methods. During the past 12 years, 6 pregnant women were admitted with an acute aortic dissection. Four had a type A and 2 had a type B dissection (Stanford classification).

Results. Two of the 4 patients with a type A dissection underwent a combined emergency operation consisting of first cesarean section and then ascending aortic repair. Cesarean section was carried out 5 days after the emergency procedure on the aorta in the third patient, and 16 weeks later in the fourth patient. All 4 fetuses were delivered alive. One fetus died 6 days later, but the other 3 are alive and well at long-term follow-up. Of the 2 patients with a type B dissection, 1 was operated on for celiac ischemia; the other was treated medically. In both cases the fetus died in utero. There were no maternal deaths in either group. Conclusions. Cesarean section with concomitant aortic repair is recommended for pregnant women with a type A dissection, depending on the gestational age. The maternal hemodynamic status will determine the sequence of the two procedures. Medical treatment is advised for patients with a type B dissection, but surgical repair is indicated if complications such as bleeding or malperfusion of major side branches occur.

Surgery for acute type A aortic dissection in pregnant patients with Marfan syndrome

Abstract 

Objective: Acute type A aortic dissection during pregnancy can be fatal to both the mother and the fetus. The goal of the present study was to characterize the prevalence, treatment and outcomes of this dangerous condition in an effort to determine optimal management. Methods: A retrospective study was conducted using data from four Marfan patients with acute type A aortic dissection during pregnancy at our institution between 1991 and 2003. Results: The mean gestational period at the time of operative repair was 31 weeks, with a range of 26–34 weeks, and the aortic root diameter ranged from 35 to 85mm. Two of the four patients underwent a combined operation with cesarean section followed by aortic repair. One patient underwent operative aortic repair following spontaneous delivery. The final patient underwent aortic repair with the fetus remaining in situ. Median sternotomy and cardiopulmonary bypass were established via the femoral artery with direct right atria drainage and left atrial venting in all patients. Composite graft replacement combined with re-implantation of the coronary artery and aortic valve replacement were performed in three patients, and aortic valve replacement with coronary artery bypass grafting of the right coronary artery was performed in one patient. Three of four patients underwent aortic arch repair utilizing antegrade cerebral perfusion and deep hypothermia with total circulatory arrest. The patient that underwent operative correction with the fetus remaining in situ experienced fetal demise with miscarriage just after cardiac surgery, and the patient died 4 days later secondary to disseminated intravascular coagulation and multi-organ failure. The remaining three cases recovered uneventfully, and the mothers and babies were discharged in good condition. Conclusions: Based on these data, we advocate cesarean section with concomitant aortic repair for patients with Marfan syndrome and acute type A aortic dissection during pregnancy. Minimization of deep hypothermic circulatory arrest time is also recommended for cases in which the fetus remains in situ.

Do OBGYN’s know anything about Aortic Dissections in women?

 I found this strange picture via a search for on Google for a SAD picture. I am troubled and sad today after reading a story that was sent to me by a reader. It turns out that she had a pregnant daughter who was giving birth to brand new baby girl via a c-section. The apparently complained to the doctor that she had chest pains. She was sent home and complained of continuous chest pains and I am told they told her it was gas and the swelling in her feet/ankles would go away in 2 weeks. It turns out that she was trying to pass that so called “gas” in the rest room at their home and died there. She leaves behind a loving mother and the husband and baby girl will never be able to enjoy having their mother around.

This is completely outrageous! Moreover, it could have been prevented. For starters, I believe this pediatricians are clueless when it comes to even knowing what an Aortic Dissection is to begin with. Furthermore, this isn’t the first story that I have heard of a women having an aortic dissection during her giving birth to the child. If the patient had been complaining of chest pains, a “red” light should have gone off on a well trained pediatrician’s head! However, hers a classic case that a clueless doctor was only concerned about delivering a baby and not paying attention to the mother.

I am very sorry for this family and there pain from all this-pain that will linger for a lifetime. The mother of the daughter giving birth is beside herself for not going back to the ER as the pediatrician said it was just gas and it would pass. Again, a fatal mistake here! However, who’s to say that even if she’d made it to the hospital that she would have got the appropriate care as she was a ticking time bomb!

We need to insist that there is more attention brought to the forefront about this possible condition where a women could have an aortic dissection while giving birth and that the doctor delivering the baby had better be trained to at least have something register with them that due to the extreme about of pressure  giving birth, the aorta could dissect!

I hope that we can really do something here! It’s a terrible thing to have this happen to anyone.

Brian Tinsley

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