A Pregnant Woman’s Aorta Tore at 24 Weeks, and Surgeons Had to Fix It in a Chest Built in Reverse

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Surgeons at Beijing Anzhen Hospital’s aortic disease center describe the operation in a case report published in August 2026 in Interdisciplinary CardioVascular and Thoracic Surgery. The woman survived and was still doing well 10 years later. The fetus died the day after surgery.

The report arrives months after a case published in Cureus in March described a 60-year-old woman whose routine neck artery ultrasound found a major arch branch, the brachiocephalic trunk, on the left instead of the right. CT angiography confirmed situs inversus totalis, and she had no symptoms. The Beijing case shows the other side of the same anatomy: what happens when that reversed arch is the thing that breaks.

Situs inversus totalis is a congenital condition in which the chest and abdominal organs form a mirror image of the usual layout. The heart points right, the liver sits on the left, and the spleen on the right. The Cleveland Clinic puts its frequency at about 1 in every 10,000 people and notes that it is usually harmless on its own.

The woman’s emergency was an acute type A aortic dissection, a tear in the aorta’s inner wall near the heart that lets blood force its way between the vessel’s layers. MedlinePlus lists high blood pressure as a common risk factor, along with pregnancy among other risks. According to the report, she had four years of hypertension, including pregnancy-related high blood pressure, and had stopped her blood pressure medication. The authors found no clinical signs of a connective tissue disorder such as Marfan syndrome.

Echocardiography showed a flap in the ascending aorta, which had widened to 50 millimeters. CT angiography confirmed the dissection, the mirror-image anatomy, and a living fetus. It also showed the tear had spread into all three arteries rising from the aortic arch, the vessels that feed the brain and arms.

The team performed emergency replacement of the ascending aorta and the entire arch with a four-branched graft. They also placed a “frozen elephant trunk,” a stent graft extending into the descending aorta.

The reversed anatomy forced practical changes. In a mirror-image body, the brachiocephalic artery runs to the left, so surgeons would normally look to the left axillary artery, under the collarbone, to connect the heart-lung machine. In this patient, that left-sided brachiocephalic artery was compromised by the dissection, so the team avoided it. They connected bypass through the right femoral artery in the groin and through the left-sided chamber that functions as the right atrium.

To protect her brain, surgeons delivered blood directly into the true channel of the left common carotid artery while her body was cooled to 23.6 degrees Celsius.

Fetal death was detected on the first day after surgery. A cesarean delivery that preserved the uterus was performed later, after the mother developed low oxygen levels that required reintubation. The authors wrote that the loss was probably multifactorial and that the low oxygen levels were not the main cause, because the fetal death came first.

The mother left the hospital 15 days after the operation with no neurological damage. Ten years later, CT scans showed her rebuilt arch branches remained open. Some dissection remained in her descending aorta. She has not been pregnant again.

The authors concluded the repair may be feasible in experienced centers when the arch vessels and descending aorta are involved, but cautioned that it “should not be routine in pregnancy.” Their bluntest line: “Maternal technical success does not ensure foetal safety.”

Aortic dissection in pregnancy is itself uncommon. A Journal of the American Heart Association study published in 2023 counted 472 pregnancy-related aortic dissection hospitalizations among more than 68 million pregnancy-related hospitalizations in the U.S. from 2002 to 2017, or 0.69 per 100,000.

The report does not blame the tear on her reversed anatomy; it points instead to her uncontrolled blood pressure. But mirror-image anatomy can complicate diagnosis and surgical planning, because landmarks that surgeons rely on sit on the opposite side.

Situs inversus is also linked to primary ciliary dyskinesia, a disorder of the tiny hairlike cilia that help set the body’s left-right axis during development. MedlinePlus Genetics reports that about 40% of people with that disorder have mirror-image organs.

This is a single case report from one specialized center, describing an operation performed about a decade ago. It cannot show how often such surgery succeeds. People who know they have reversed anatomy may want to make sure it is clearly noted in their medical records, and anyone with sudden, severe chest or back pain should seek emergency care.

A 27-year-old woman with situs inversus totalis developed an acute type A aortic dissection at 24 weeks of pregnancy. Surgeons in Beijing replaced her ascending aorta and aortic arch. She recovered, but the fetus died the day after surgery.

Did situs inversus cause the aortic tear?

The report does not say so. She had long-standing high blood pressure and had stopped her medication, and hypertension and pregnancy are both recognized risk factors.

Why does mirror-image anatomy matter during surgery?

Arteries, heart chambers and organs sit on the opposite side, so surgeons must adapt where they connect bypass lines. Here, the team avoided the compromised left-sided arch branch and used the right femoral artery instead.

It affects about 1 in 10,000 people. Many people learn they have it only through an unrelated scan or exam.

What can people with reversed anatomy do?

They can make sure the condition is documented in their medical records and mention it to new clinicians, especially before procedures or during emergencies.