Ukrainian Journal of Perinatology and Pediatrics. 2020. 2(82): 27-34; doi 10.15574/PP.2020.82.27
Davydova Iu. V.^1,2, Siromaha S. O.², Kravchenko V. I.², Lymanska A. Y.¹, Naumchik О. М.^1
1SI «Institute of Pediatrics, Obstetrics and Gynecology named of academician O.M. Lukyanova NAMS of Ukraine», Kyiv
²SI «Amosov National Institute of Cardiovascular Surgery», Kyiv

For citation: Davydova IuV, Siromaha SO, Kravchenko VI, Lymanska AY, Naumchik ОМ. (2020). Aortic aneurysm of major vessels during pregnancy. Multidisciplinary approach. Ukrainian Journal of Perinatology and Pediatrics. 2(82): 27–34. doi 10.15574/PP.2020.82.27
Article received: Jan 23, 2020. Accepted for publication: May 30, 2020.

Purpose — to develop an algorithm of obstetric and cardiac surgical tactics in women of reproductive age with aneurysmal lesions of the major vessels.
Materials and methods. An analysis of the world experience of managing patients with aortopathies combined with pregnancy from English, Ukrainian, Russian literature sources of databases PubMed, Medscape, Google Search, Elsevier for the last 10 years. 19 sources were analyzed, which included review articles, data from cohort studies. The publications with the largest series of analyzed cases were selected for analysis. Review articles were selected with the largest number of analyzed studies. The guidelines of the European Society of Cardiology 2018 (ESC 2018) were taken into account to determine the recommendations. The experience of the multidisciplinary team «Obstetric Cardiology» with this group of pregnant women for 6 years is presented.
Results and conclusions. Marphan syndrome is recognized as a leading risk factor for aortic dissection during pregnancy. The most dangerous are the third trimester of pregnancy and the postpartum period. Preconception counseling of women risk-group is substantial, it is important also for identification of women who are contraindicated in pregnancy without elimination of pathological conditions of the aorta, as well as the development of an individual pregnancy plan by a multidisciplinary team with a proven algorithm for tactical decisions in case of complications. The multidisciplinary team «Obstetric Cardiology» uses recognized global trends in the treatment of women with aortic dissection in the antenatal and postnatal periods with successful results.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest were declared by the authors.
Key words: aortopathy, aortic dissection, pregnancy, aortic aneurysm, type А aortic dissection, thoracic aortic aneurysm.

REFERENСES

1. Kim GI. (2018). Sohranenie aortalnogo klapana pri hirurgicheskom lechenii rassloeniya voshodyaschego otdela aortyi: dissertatsiya na soiskanie uchenoy stepeni kandidata meditsinskih nauk. Sankt-Peterburg: 204.

2. Lazoryshynez VV, Siromakha SO, Rudenko KV, Prokopovych LM, Davydova YuV, Limanska AYu. (2016). Life-threatening conditions in pregnant's with cardiovascular pathology: multidisciplinary approach. Perinatologiya and pediatriya. 1 (65): 18–21. doi 10.15574/PP.2016.65.18

3. Lazoryshynets VV, Davydova IuV, Limanskaya AIu, Siromakha SO. (2019). Difficult GUCH patient in obstetric practice: multidisciplinary approach to cardio-perinatal management. Perinatologiya and pediatriya. 1 (77): 5—11. https://doi.org/10.15574/PP.2019.77.5

4. Martyshyn OO. (2017, Sep 15). Materynska smertnist v Ukraini: zaproponovano shliakhy vyrishennia problemy. Ukrainskyi medychnyi chasopys: 1—4.

5. Siromakha SO, Davydova YuV, Lymanska AIu, Lazoryshynets VV. (2019). Multydystsyplinarnyi suprovid vahitnykh i porodil iz vrodzhenoiu vadoiu sertsia. Visnyk sertsevo-sudynnoi khirurhii. 1: 31—37.

6. Assad RS. (1992). Extracorporeal circulation in the isolated in situ lamb placenta: hemodynamic characteristics. J Appl Physiol. 72: 2176—2180. https://doi.org/10.1152/jappl.1992.72.6.2176; PMid:1629070

7. Ch'ng SL. (2013). Stanford Type A Aortic Dissection in Pregnancy: A Diagnostic and Management Challenge. Heart, Lung and Circulation 13; 22: 12—18. https://doi.org/10.1016/j.hlc.2012.08.005; PMid:23084107

8. Coulon C. (2015, November). Thoracic aortic aneurysms and pregnancy. La Presse Medicale. 44 (11): 1126—1135. https://doi.org/10.1016/j.lpm.2015.02.024; PMid:26454306

9. ESC. (2018). Guidelines for the management of cardiovascular diseases during pregnancy. European Heart Journal. 39: 3165—3241.

10. Kamel H. (2016). Pregnancy and the risk of aortic Dissection or rupture. A cohort-crossover analysis. Circulation. 134: 527—533. https://doi.org/10.1161/CIRCULATIONAHA.116.021594; PMid:27492904 PMCid:PMC4987245

11. Liu Yu-Yong. (2017). Treatment of patients with aortic disease during pregnancy and after delivery. Journal of International Medical Research. 45 (4): 1359—1368. https://doi.org/10.1177/0300060517711088; PMid:28587539 PMCid:PMC5625542

12. Nienaber CA. (2004). Gender-Related Differences in Acute Aortic Dissection. Circulation. 109: 3014—3021. https://doi.org/10.1161/01.CIR.0000130644.78677.2C; PMid:15197151

13. Sawlani N, Shroff A, Vidovich MI. (2015). Aortic dissection and mortality associated with pregnancy in the United States. J Am Coll Cardiol. 65: 1600—1601. https://doi.org/10.1016/j.jacc.2014.12.066; PMid:25881947

14. Silaschi M. (2017). Aortic dissection: medical, interventional and surgical management. Heart. 103; 1: 78—87. https://doi.org/10.1136/heartjnl-2015-308284; PMid:27733536

15. Tara O`Neill Hayes (2019, September 9). Maternal Mortality in The United States. American action forum.

16. Thalmann M. (2011). Acute type A aortic dissection and pregnancy: a population-based study. European Journal of Cardio-thoracic Surgery. 39: e159—e163. https://doi.org/10.1016/j.ejcts.2010.12.070; PMid:21353789

17. Wanga S, Silversides C. (2015). Pregnancy and Thoracic aortic disease: managing the risks. Canadian Journal of Cardiology: 1—8. https://doi.org/10.1016/j.cjca.2015.09.003; PMid:26604124

18. Yuan SM. (2013). Aortic dissection during pregnancy: a difficult clinical scenario. Clin Cardiol. 36: 576—584. https://doi.org/10.1002/clc.22165; PMid:23843107 PMCid:PMC6649420

19. Zhu Jun-Ming. (2017). Aortic dissection in Pregnancy: Management, strategy and outcomes. ANN Thorac Surg. 103: 1199—1206. https://doi.org/10.1016/j.athoracsur.2016.08.089; PMid:27825688