2024 Volume 28 Issue 1 Pages 97-101
Aortic dissection in young women is rare, and approximately half of the cases are associated with pregnancy. Obstetrical hemorrhage due to heparin use is a problem with aortic replacement after cesarean section and postpartum. We report an experience with anesthetic use in a young woman who developed acute aortic dissection immediately after delivery and underwent aortic root replacement.
A 38-year-old woman was brought to our hospital with chest and back pain after vaginal delivery. She underwent Bentall and coronary artery bypass surgeries for acute aortic dissection of Stanford type A and suspected coronary artery dissection. Preoperative discussion of the management of obstetrical hemorrhage was done with an obstetrician. It was decided that aortic root replacement was the highest priority due to suspected coronary artery dissection. Hence, a prophylactic total hysterectomy was not performed. Prophylactic administration of uterotonics was avoided because of the possible progression of coronary artery dissection due to elevated blood pressure. Propofol, a weak uterine relaxant, was used as a sedative, and blood loss following delivery was estimated by the operating room staff from sheets soaked with blood and loss of circulating blood volume. Uterotonics, placement of intrauterine balloon tamponade, and total hysterectomy were planned in case of obstetric hemorrhage. The surgery was completed without obstetrical hemorrhage, and she was discharged on the postoperative day 13.
During the Bentall operation immediately after delivery, it was important to prevent obstetric hemorrhage. We safely manage the patient in collaboration with related departments and operating room staff.
