“Adults and children should do their best to protect!” Recently, the First Affiliated Hospital of China University of Science and Technology (Anhui Provincial Hospital) successfully treated A pregnant woman whose life was in danger of sudden type A aortic dissection. “Little leaf medical exploration” learned that the hospital’s multidisciplinary team of cardiac macrovascular surgery, obstetrics and gynecology, pediatrics, anesthesiology, operating room, critical care medicine and other disciplines worked closely together, and successfully completed caesarean section and cardiac macrovascular surgery after more than 10 hours of intense rescue.
At present, the mother and baby are safe and recovering well, and will be discharged soon.In mid-October this year, Ms. Xue, who was 29 weeks pregnant, suddenly felt severe back pain at home and was immediately sent to the local hospital in Bozhou for treatment by her family.
In combination with the heart color ultrasound examination, the doctor considers the patient to be A type A aortic dissection, which requires immediate surgical treatment, otherwise it will endanger the life of the pregnant woman and the fetus at any time.
It is understood that acute aortic dissection is an extremely dangerous cardiovascular critical illness, patients with aortic intima tear, blood flow between the intima and the media, resulting in stratification of the blood vessel wall, making part of the aortic wall only a thin layer of outer membrane, like a balloon filled with water, is a “time bomb” in the body, easy to rupture, resulting in massive bleeding death.
Emergency surgery is urgent! After receiving the referral call, the first affiliated Hospital of China University of Science and Technology (Anhui Provincial Hospital) quickly launched a multidisciplinary joint treatment mechanism and opened a green channel for Ms. Xue.
Emergency medicine, cardiovascular surgery, obstetrics and gynecology, imaging, anesthesiology, operating room, pediatrics and other departments of experts immediately combined with pregnant women’s information and disease conditions for consultation. Based on imaging and clinical evaluation, the patient was diagnosed with A type A aortic dissection with placental abruption.
Relay for Life: A multidisciplinary team worked for 10 hours to protect mother and daughterFor the special situation of pregnant women, the expert group launched an in-depth discussion: if the aortic dissection surgery of pregnant women is performed first, after a long period of anesthesia and deep low temperature cardiopulmonary bypass, the fetus in the abdomen will not survive.
If cesarean section is performed first, the mother faces the risk of aortic dissection rupture at any time, and aortic surgery under cardiopulmonary bypass will use a large amount of heparin to prevent blood clotting, which is prone to postpartum uterine bleeding.
Considering that Ms. Xue’s pregnancy has reached 29 weeks, the fetus has been basically fully developed, and she has had birth experience before, after obtaining the consent of her family and myself, the expert group fully discussed and formulated a three-step treatment plan: first, maintain the stable heart rate and blood pressure of the pregnant woman through general anesthesia.
Under the premise of ensuring the safety of pregnant women as much as possible, emergency cesarean section is performed to save the child, while the uterus is removed to prevent massive bleeding; Finally, total aortic arch replacement was performed.In the afternoon, the Relay for Life rescue began with an emergency cesarean section performed by the obstetrics and gynecology team.
In order to reduce the impact of anesthesia on fetal development, after the pregnant woman’s general anesthesia, the doctor takes out the fetus within 2 minutes. The neonatology staff, who had already been waiting, immediately sent the 800-gram premature baby to the neonatology department for follow-up treatment after ensuring the girl’s vital signs were stable.
Subsequently, the key baton was handed over to the heart and vascular surgery team, and the medical staff relayed the total aortic arch replacement surgery for Ms. Xue. Intraoperative exploration revealed that Ms. Xue’s dissection was torn from the ascending aorta root to below the femoral artery of both thighs, with a length of nearly one meter.
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