Chest Pain in Pregnancy Part II: Aortic Dissection

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Kamal G., M.D. -

Any thought about using MRI to r/o thoracic aortic dissection in pregnancy?

Rebecca B., MD -

Hello! MRI is indeed a very sensitive and specific imaging modality for aortic dissection. However, I see a few potential issues with its use. First, it would depend on the stability off the patient and the relative safety of putting an unstable acute aortic dissection patient in an MRI machine potentially far away from the ED without immediate access due to the length of the test, etc. That aside, MRI for aortic dissection relies on use of gadolinium for aortic angiography to identify the dissection. Gadolinium is contraindicated in pregnancy, which precluding its use in the pregnant patient. There is not a wealth of data, but the studies on gadolinium are based on on patients who mostly had accidental exposure during pregnancy in the first trimester and looking at outcomes in those populations as compared to a cohort. However, exposure to gadolinium is associated with a range of adverse outcomes in neonates, leading to its avoidance. As you can imagine, with that, there are no randomized controlled trials that will help figure this out! There are some non-gadolinium protocols for aortic dissection but these are more specialized and less widespread in availability with less information on their specificity and sensitivity. Thank you for listening and thank you for your question! -R. Bavolek

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