Clinical and laboratory characteristics
The clinical and laboratory characteristics of patients are summarized
in Table 1. All patients had complicated TBAD. The age range of the
patients was 27 to 44 years, and the range of gestational weeks at
admission was 27 weeks plus three days to 36 weeks plus six days. Among
these patients, none of them had diabetes, chronic hypertension,
connective tissue disorder, or cardiovascular disease before pregnancy.
However, three patients developed pre-eclampsia during pregnancy. In
addition, all patients were multipara and had a history of cesarean
section. All five patients presented with severe chest pain and/or back
pain. Since the occurrence of thoracic back pain, three patients showed
elevated blood pressure, and two of them had refractory hypertension.
All patient has asymmetric blood pressure. Only one patient had a
cardiac function rating of Ⅲ, while the other three patients had a
cardiac function rating of Ⅱ. Additionally, one patient had signs of
threatened premature delivery, including uterine contraction and
cervical shortening.
All five patients had a CTA test after admission and showed typical
signs of complicated TBAD (Figure 1). Three patients’ lesions were
evaluated from the aortic arch. In contrast, the lesion formation of
another two patients started distal to the left subclavian artery. Three
patients had imaging evidence of malperfusion, mainly manifested as
extensive arterial involvement, including the renal artery, celiac
trunk, and superior mesenteric artery. The range of aortic width was
18.57-31.35mm. One patient’s cardiac ultrasound showed aortic
regurgitation and aneurysmal dilatation of the aortic sinus. Data from
laboratory tests showed that four of the five patients had elevated
level of D-Dimer, with an average of (719 ± 243.79) ng/L. Four patients
had increased lymphocyte ratio (mean value: 86.74 % ± 7.22%), three of
which had elevated white blood-cell counts (mean value 13.54 ±
4.54×109/L). Pro-BNP and myocardial enzymes were in the normal range in
all patients.