Aortic dissections in Marfan disease during pregnancy: Review article

Abstract

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.

Aorta pathology and pregnancy-related risks in adult congenital cardiac disease: does the aorta dilate during pregnancy?

“…6 In MS, most of dissections occur in the ascending aorta and the risk can be as high as 10% if the aortic size exceeds 40 mm. [7][8][9][10] The highest risk is in the third trimester and peripartum, but also years after due to an accelerated aortic growth during pregnancy. [11][12][13][14] Overall, it is estimated that there is about a 1% risk of fatal complication rate during pregnancy in Marfan patients.…”