Peripartum type B aortic dissection in patients with Marfan syndrome who underwent aortic root replacement: a case series study

Abstract

MFS patients after prophylactic ARR are still at high risk of type B aortic dissection during the peripartum period.

Pregnancy after Aortic Root Replacement in Marfan's Syndrome: A Case Series and Review of the Literature

“… 2 4 Women with Marfan's syndrome and aortic dilatation (especially > 45 mm) may be counseled to undergo aortic root repair prior to pregnancy to reduce the risk of aortic dissection, 5 6 although this has not been proven to be entirely protective. 4 7 8 9 10 …”

Authors' reply re: Peripartum type B aortic dissection in patients with Marfan syndrome who underwent aortic root replacement: a case series study

“…They report a 60% dissection rate in their cohort, which is worryingly high, but we wish to highlight several points. First, their cohort is very small, with only 14 women who met the Ghent criteria for Marfan syndrome; 2 furthermore, only five of these women had an aortic root replacement prior to pregnancy. Secondly, it is unclear whether any of the women received counselling prior to pregnancy and whether the risk of dissection was discussed with them.…”

“…2 As indicated by Cauldwell et al, the sample size was small, with 14 women meeting the Ghent criteria for Marfan syndrome (MFS), and only five having had aortic root replacement (ARR) prior to conception. However, there has never been a report claiming that patients with a surgical history of aortic root aneurysm still have a higher risk of type B aortic dissection during the perinatal period, and we feel the dissection rate of 60% in the post-ARR group is strikingly high and deserved attention in perinatal care.…”

“…2 In our view, immunomodulation in endometriosis may involve biochemical/ metabolic cross-talk(s) among cell surface/transmembrane receptors, ion channels, growth factors, cytokines, chemokines, thereby altering natural killer cell activity, aberrant cell proliferation, autophagy and/or programmed cell death, including apoptosis. Furthermore, non-pharmacologic intervention (s) such as personalised psychological supportive therapy may potentially advance the birth rate trends among women with recurrent miscarriage, thereby significantly reducing the emotional distress associated with the cost of treatment.…”

Re: Peripartum type B aortic dissection in patients with Marfan syndrome who underwent aortic root replacement: a case series study

“…We read with interest work published by Sayama et al . illustrating cases of Type B dissection in pregnancies in women with Marfan syndrome with a repaired aortic root.…”