Aortic root valve‐sparing repair and dissections in Marfans syndrome during pregnancy: A case series

Cottrell, Jesse; Calhoun, J. T.; Szczepański, J; Corvera, Joel S.; Creswell, Lawrence L.; Kogon, Brian; Hasaniya, Nahidh; Copeland, Hannah

doi:10.1111/jocs.14592

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…The decision to proceed with pregnancy in VEDS is complex, and historically people with VEDS have been advised against pregnancy ( 20 , 37 ). However, individuals with null mutations may be at lower risk for complications in pregnancy ( 3 ).…”

Section: Pre-conception Counselingmentioning

confidence: 99%

Obstetric considerations for aortopathy in pregnancy

Whelan,

Ringel,

Shalhub

et al. 2023

Ann Cardiothorac Surg

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Aortic dissection (AD) associated with pregnancy can have catastrophic consequences for the mother and/or fetus. AD occurs in 4–5 per 1,000,000 pregnancies and, despite its rarity, is the third most frequent maternal cardiovascular cause of death. AD associated with pregnancy is most likely to occur in the third trimester or postpartum period. In individuals with genetic aortopathy, pregnancy is considered a high-risk time for AD. There are management strategies in the preconception, antepartum, delivery and postpartum periods to optimize patient care. A multi-disciplinary team that includes capability to perform cardiovascular surgery is critical. Imaging modalities including maternal echocardiogram and magnetic resonance imaging can be safely performed in pregnancy for surveillance of the aortic size. Computed tomography (CT) scan is reserved for scenarios where there is a high index of suspicion for AD in a pregnant person to limit fetal exposure to radiation. After counseling about the potential risks of a pregnancy, the decision to pursue pregnancy is ultimately at the discretion of the individual. The duty of the cardio-obstetric team is to ensure that the patient and their family understand the risks of a pregnancy and the plan of care.

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Section: Pre-conception Counselingmentioning

confidence: 99%

Obstetric considerations for aortopathy in pregnancy

Whelan,

Ringel,

Shalhub

et al. 2023

Ann Cardiothorac Surg

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“…A retrospective study of 35 patients suggested rate of aortic root and aortic dilation was similar between pregnant and nonpregnant women when diagnosed with Marfan syndrome [26]. Cottrell et al [27] published a case series of four patients with Marfan syndrome and evidence-based suggestions for the pregnant woman with Marfan syndrome. Specific risk factors include an aortic root diameter greater than 4.0 cm, an increase of 0.5 cm/year over serial echocardiograms, or history of aortic dissection.…”

Section: Congenital Vascular Malformations and Connective Tissue Diseasementioning

confidence: 99%

Peripartum considerations for women with cardiac disease

Hussey

Meng

2021

Current Opinion in Anaesthesiology

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Purpose of reviewThe aim of this review of cardiac disease in pregnancy is to delineate current best practices and highlight emerging themes in the literature. Recent findingsCardiovascular disease is the leading cause of death among pregnant women in the United States. Many clinicians and institutions have developed care pathways to approach care in these high-risk patients including highly coordinated multidisciplinary teams. The diagnosis of pulmonary hypertension is the greatest risk factor for an adverse event in pregnant women. Vaginal delivery, with good neuraxial anesthesia, is usually the preferred mode of delivery in women with cardiac disease, although the rate of cesarean delivery is higher among women with heart disease.

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“…We read with great interest the article by Cottrell et al 1 Their recommendation stands that in the presence of efficient and effective multi-disciplinary team approach toward the care of Marfan patients; pregnancy can be encouraged in these patients.…”

Section: Marfan Syndrome Aortic Dissection and Pregnancy-the Triplementioning

confidence: 99%