Acute Aortic Dissection in Pregnancy in a Woman with Undiagnosed Marfan Syndrome

Master, Mandana; Day, Gavin

doi:10.1155/2012/490169

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…However, the authors did not include previously healthy women in the evaluation. Of special interest, 1 patient included in this study had 2 segmental AoDs in the ascending aorta and descending aorta simultaneously, which was taken as a type A + B AoD by the authors . However, it might be categorized as type A. Takayasu arteritis most commonly involves the aortic arch and its major branches, leading to aortic‐wall weakening and eventual aneurysmal formation or dissection .…”

Section: Discussionmentioning

confidence: 99%

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Yuan

2013

Clinical Cardiology

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Aortic dissection (AoD) during pregnancy is a rare but lethal condition and highlights the need for extensive elucidation. The aim of this study is to reveal the risk factors for AoD during pregnancy and to compare the 2 main risk factors, Marfan syndrome and pregnancy itself in the previously healthy woman. The pregnant patients developed AoD at 31.7 ± 7.6 weeks of gestation. It occurred much earlier in the Marfan patients than in the previously healthy women (30.7 ± 8.6 weeks of gestation vs 34.4 ± 4.4 weeks of gestation, P = 0.0263). In the Marfan patients, AoD developed in 3 (3.2%), 15 (15.8%), and 43 (46.3%) patients in the 3 trimesters, respectively, compared with 31 of the previously healthy women, and only in the third trimester. The neonates of the Marfan patients had better Apgar scores at 1 and 5 minutes, lower intubation rates, and fewer stays in the neonatal intensive care unit than those of the previously healthy women. Marfan syndrome and pregnancy itself in the previously healthy woman were the 2 main risk factors responsible for the occurrence of AoD during pregnancy. Marfan patients may develop AoD at an early age and an early stage of pregnancy, probably due to the preexisting weakened aortic wall. Better outcomes for the surviving neonates of Marfan patients compared with neonates of the previously healthy women might be the result of the poor condition of Marfan patients causing a higher death rate for those fetuses.

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Section: Discussionmentioning

confidence: 99%

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Yuan

2013

Clinical Cardiology

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“…We identified 4 case reports of pregnancy‐related AAD in patients with undiagnosed MFS. In these cases, the diagnosis of Marfan syndrome was made by genetic testing after the patient presented with a dissection . Chang, Katsuragi, and Lichtman reported cases where no Ghent features were identified other than the acute aortic event.…”

Section: Discussionmentioning

confidence: 99%

“…We identified 50 articles that fit our inclusion criteria (41 solitary cases and 9 case series) . The 50 articles yielded a total of 72 patients who met the inclusion criteria (AAD during pregnancy or within 1 year postpartum).…”

Section: Methodsmentioning

confidence: 99%

Pregnancy-related acute aortic dissection in Marfan syndrome: A review of the literature

Smith

Gros

2017

Congenital Heart Disease

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A well-established association exists between acute aortic dissection and pregnancy, particularly in women with Marfan syndrome. However, there is debate regarding appropriate management guidelines. In particular, there are differing opinions regarding when prophylactic aortic root repair should be recommended as well as the efficacy of beta blockers in this clinical scenario. The current study evaluated 10 years of published literature (2005-2015) in the PubMed/Medline database. Fifty articles, describing 72 cases of women who presented with aortic dissection in the antepartum or postpartum period were identified. Comparisons on demographic variables and clinical outcomes between cases of women with Marfan syndrome (n = 36) and without Marfan syndrome (n = 36) were conducted. There were no significant differences in demographics (age, gravidity, parity) between the Marfan and non-Marfan cases. Marfan patients presented with antepartum dissections significantly earlier in pregnancy than those without Marfan syndrome (P = .002). However, there were no significant difference between the 2 groups in maternal mortality, fetal mortality, or obstetric outcomes (mode of delivery and gestational age at delivery). Eight cases described events in Marfan women with an aortic root diameter ≤40 mm. Six events occurred in Marfan women who were managed with beta blockers. Current guidelines rely on aortic root diameter for stratification of Marfan women into risk categories, but we identified several cases that would be missed by these guidelines. Specifically, the existing literature suggest that women with Marfan syndrome should take precautions throughout pregnancy, rather than the third trimester.

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“…Maternal and fetal mortality were reported in two patients, and fetal loss in two cases despite of maternal survival. Reviewing the English literature between 1995 and May 2017 (23-35), we found 38 additional MFS cases with pregnancy-related complications (36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52). Sixty-three women developed an acute AoD: 59% of the ascending aorta, 32% of the descending aorta and both in 9%.…”

Section: Risk For the Mothermentioning

confidence: 99%

Pregnancy and Marfan syndrome

Goland¹,

Elkayam²

2017

Ann. Cardiothorac. Surg.

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Pregnancy in women with Marfan syndrome (MFS) presents challenges to the clinician and the patient due to the increased incidence of maternal complications and involvement of the fetus, and deserves special consideration. The leading cause of morbidity and mortality in MFS is aortic dissection. This article presents an extensive review of available clinical information and provides recommendations for the management of patients with MFS during pregnancy.

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Acute Aortic Dissection in Pregnancy in a Woman with Undiagnosed Marfan Syndrome

Cited by 9 publications

References 6 publications

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Pregnancy-related acute aortic dissection in Marfan syndrome: A review of the literature

Pregnancy and Marfan syndrome

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