High-Risk Cardiac Disease in Pregnancy

Abstract

Heart disease continues to be the leading cause of nonobstetric maternal morbidity and mortality. Early diagnosis and appropriate care can lead to prevention of complications and improvement of pregnancy outcome. This paper continues the review and provides recommendations for the approach to high-risk cardiovascular conditions during gestation.

Pregnancy and Marfan syndrome

“…Although in the past life expectancy was reported to be greatly reduced, significantly better life expectancy due to improved medical and surgical treatment has been recently described (7). The leading cause of morbidity and mortality in MFS is aortic dissection (AoD) (1,4,(8)(9)(10).…”

“…The most serious complication in patients with MFS is AoD, and the risk is substantially increased during pregnancy and the post-partum period (PP) (4,(8)(9)(10)12,13 Having one of the features listed constitutes a major criterion or minor criterion for all systems except the skeletal system, where more than one feature is needed. ULSR, upper to lower ratio.…”

“…The expected rate of AoD is ranging from 1% in women with aortic diameter <40 mm to as much as 10% in high-risk patients (those with aortic root diameter >40 mm, rapid dilatation or previous dissection of the ascending aorta) (3,9,53,59). Despite the rare occurrence of AoD in women with MFS and a normal size aorta (3,9,18,59,60), an event-free pregnancy cannot be guaranteed in these women as well (19,20,61,62). Although AoD occurs in most women during the third trimester and the PP, it may also occur at any time of gestation (8,9,59).…”

“…Most often AoD occurred in MFS women in their 3 rd decade of life, it is advisable therefore, to plan a pregnancy at a younger age (7,18). Patients should be told of the need for a close follow up and treatment with a high dose beta-blockers during pregnancy and the PP period (8,10,59) and be educated of symptoms related to AoD and the need for an immediate care. In addition, women should be informed that previous aortic surgery cannot guarantee uneventful pregnancy and cannot eliminate the risk of recurrent dissection in other parts of the aorta.…”

“…Elective aortic root replacement can be performed with low morbidity and mortality (64,75,76). For this reason, women with MFS with indications for elective surgery should undergo aortic root replacement prior to pregnancy (10,74).…”