Introduction
Marfan syndrome is a connective tissue disorder caused by mutations in the fibrillar FBN‐1 gene. Aortic dissection and rupture are major causes of morbidity and mortality and are of special concern during pregnancy.
Materials and Methods
The authors report four cases of aortic root repair with preservation of the native aortic valve that have has created a discussion between cardiothoracic surgeons, obstetricians, and gynecologists regarding the best care for Marfan syndrome patients. We present these cases here with a review of the literature.
Results
Surgery of the aorta and valves in Marfan syndrome is less risky than in previous eras and surgical management guidelines are generally accepted. Yet, we may be unnecessarily referring women to terminate pregnancies or to avoid pregnancy. We believe there may be alternative options for these patients.
Conclusions
Marfan syndrome during pregnancy can be navigated with preconception counseling, antepartum care, and close postpartum follow‐up involving an appropriate multidisciplinary team.
Certainly, the reduction of adverse outcomes would be improved with early knowledge of Marfan syndrome in the mother which would aid in preparation and clinical consideration during the perioperative period and, of course, in general. Each of the cases presented in our paper had established diagnoses and lends weight to this suggestion. The work by Meijboom et al 1 was indeed encouraging as we constructed our recommendations for evaluating the risk to a potential mother. The conclusion of that paper, as we discussed in our review, was that pregnancy is likely safe up to an aortic root diameter of 45 mm 2 , and speaks to the value of early detection of disease. 1 The recently released work by Dr Harky identifies the Marfans population in England and Wales undergoing planned and nonplanned aortic root surgery, and assesses outcomes. While it does not specifically address Marfans in pregnancy, it reported satisfactory outcomes for 306 Marfans patients, 100 of which were female, and suggests, as our paper does, that Aortic root surgery in this cohort remains an evolving but achievable challenge. 2 The call for an international registry to assess the work up and outcomes of this patient population is a worthy one which we would be happy to participate in.
Studies have been conducted to determine the feasibility of using aileron or spoiler controls as alternates to pitch control for large horizontal axis wind turbines. The NASA MOD-O machine was used as the basis for this study. Results of the study show that either ailerons or spoilers can provide control necessary to limit turbine power in high wind conditions. An aileron system is recommended for the present application, based upon the ability of ailerons to provide self-starting and added power at low wind speed conditions. The preliminary design study including aileron component sizing and maximum hinge moments was completed and ailerons will be fabricated for testing on the MOD-O turbine. Nomenclature c = airfoil or blade local section chord C p -rotor power coefficient, power/ Vip V 3 irR 2 R = maximum blade radius V = wind velocity x = spanwise distance from center of rotor X = tip speed ratio, uR IV d a = aileron deflection angle, positive down (upwind) d s = aileron deflection angle, positive up (downwind) a; = rotor angular velocity
We want to thank Dr. Raveenthiran and Dr. Harky for their interest in our paper and in the topic of Marfans in the setting of pregnancy. Certainly, the reduction of adverse outcomes would be improved with early knowledge of Marfans syndrome in the mother which would aid in preparation and clinical consideration during the perioperative period, and, prior to pregnancy.
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