Abordagem da dissecção aguda de aorta na gestação

Abstract

Acute aortic dissection (AAD) is a relatively rare event in pregnant women, although it has high rates of perinatal mortality and morbidity, affecting about 4 women in every 1 million during pregnancy and puerperium. The wall of the aorta is composed of three layers: intima, media and adventitia. Constant exposure to high pulsatile pressure and shear stress leads to a weakening of the aortic wall, resulting in a rupture of the intima. Following this tear, blood flows into the intima-media space, creating a false lumen. Most of these ruptures occur in the ascending aorta, usually in the right lateral wall, where the greatest strain on the aorta occurs. Pregnancy, especially in the third trimester, is one of the risk factors for the development of acute aortic dissection. The objective of the present study is to demonstrate in a panoramic way which diagnostic, clinical and surgical approaches have the best evidence against acute aortic dissection in pregnancy. For the elaboration of this work, a bibliographic review was carried out in national and international literature of the last 30 years on the proposed theme. It was found that, although a relatively rare event, clinicians should maintain a high index of suspicion for AAD in any pregnant woman who experiences acute-onset chest pain. Early recognition in addition to successful coordination of care can lead to a positive maternal-fetal outcome.