Postpartum aortic dissection

Yuan, Shi‐Min

doi:10.1016/j.tjog.2013.06.003

Cited by 28 publications

(31 citation statements)

References 25 publications

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“…We considered any aortic event during pregnancy, delivery, or in the immediate postpartum period (up to 6 months after delivery [7]) as "immediate". These included dissecting aneurysms and the need for urgent or elective aortic repair ( Table 4).…”

Section: Immediate Aortic Outcome Of Pregnancymentioning

confidence: 99%

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Marfan Syndrome Versus Bicuspid Aortic Valve Disease: Comparative Analysis of Obstetric Outcome and Pregnancy-Associated Immediate and Long-Term Aortic Complications

Toprak

Szöcs

Zengin-Sahm

et al. 2020

JCM

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Pregnancy poses a threat to women with aortopathy. Conclusive data on the obstetric and aortic outcome in this risk collective, especially when it comes to aortic complications in the long term, are still missing. This study offers a comparative analysis of pregnancy-associated outcome in 113 consecutive women with Marfan syndrome or bicuspid aortic valve disease, including 46 ever-pregnant and 37 never-pregnant women with Marfan syndrome, and 23 ever-pregnant and 7 never-pregnant females with bicuspid aortic valve disease. The overall obstetric outcome was comparable between ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease (p = 0.112). Pregnancy-associated aortic dissection occurred in two women with Marfan syndrome (3%) during a total of 62 completed pregnancies, whereas no single case of aortic event occurred in women with bicuspid aortic valve disease during a total of 36 completed pregnancies (p = 0.530). In the long-term follow-up, aortic dissection occurred in 21% of ever-pregnant women with Marfan syndrome, but in none of the women with bicuspid aortic valve disease (p = 0.022). Proximal aortic surgery was performed with similar frequency in ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease in the long term (p = 0.252). However, ever-pregnant women with Marfan syndrome were younger when surgery was performed (44 ± 9 vs. 59 ± 7 years; p = 0.041). In Marfan syndrome, long-term growth of the aorta was comparable between ever-pregnant and never-pregnant women. Pregnancy thus exhibited an increased immediate aortic risk only in women with Marfan syndrome, but not in women with bicuspid aortic valve disease. Previous pregnancy did not relate to an increased long-term risk of adverse aortic events in women with Marfan syndrome or with bicuspid aortic valve disease.

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Section: Immediate Aortic Outcome Of Pregnancymentioning

confidence: 99%

“…In women younger than 40 years, 50% of dissecting aneurysms occur during pregnancy or in the immediate postpartum period [6]. Therefore, many authors consider pregnancy as an important risk factor for adverse aortic events [7,8].…”

Section: Introductionmentioning

confidence: 99%

Marfan Syndrome Versus Bicuspid Aortic Valve Disease: Comparative Analysis of Obstetric Outcome and Pregnancy-Associated Immediate and Long-Term Aortic Complications

Toprak

Szöcs

Zengin-Sahm

et al. 2020

JCM

View full text Add to dashboard Cite

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“…The additional hemodynamic stress of pregnancy, labor, and delivery may increase the risk of aortic complications, thus steps to avoid these complications, such as serial imaging of the aorta, alteration of delivery method, or delivering at an earlier gestation age, may be needed. An aortic aneurysm >4 cm is a major indication for cesarean section, as this may predispose a woman to a potentially fatal aortic dissection (Immer et al 2003;Yuan 2013).…”

Section: Deliverymentioning

confidence: 99%

At the Heart of the Pregnancy: What Prenatal and Cardiovascular Genetic Counselors Need to Know about Maternal Heart Disease

Morales

Allain

Arscott

et al. 2017

Journal of Genetic Counseling

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In the last decade, an increasing number of cardiac conditions have been shown to have a genetic basis. Cardiovascular genetic counseling has emerged as a subspecialty aiming to identify unaffected at-risk individuals. An important sector of this at-risk population also includes expectant mothers, in whom unique clinical challenges may arise. Genetic counselors, especially those in cardiovascular and prenatal settings, have an opportunity to identify and assist women who may benefit from cardiovascular care during pregnancy. This paper provides basic management and genetic evaluation principles for affected women, as well as guidance on identifying those who are at risk. We provide considerations for cardiac surveillance in pregnancy and the post-partum period. Finally, key psychosocial issues that appraise how to best provide support to at risk women as they make informed decisions are discussed. We propose that a team approach including cardiology, maternal fetal medicine, and genetic counseling best serves this patient population. Ongoing questions addressing an evidence based approach to cardiovascular genetic conditions in pregnancy still remain. Thus, well-designed research protocols are essential to mark progress in this area.

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“…49 Patients with Marfan Syndrome have been reported to have a high rate of aortic dissection during pregnancy, however at least one national study suggested that the risk was relatively low if patients received appropriate pre and perinatal care. [50][51][52][53][54][55] Ehlers Danlos Syndrome has several forms and there are several reports of pregnancy-associated complications, a number of which have been life-threatening. 56 There remains no consensus as to the absolute risk that women with Ehlers Danlos Syndrome confront during pregnancy or the best timing for interventions to prevent complications.…”

Section: Pregnancy and Hereditary Ocular Syndromic Disordersmentioning

confidence: 99%

Gender Specific Issues in Hereditary Ocular Disorders

Iragavarapu¹,

Gorin²

2014

Current Eye Research

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This review is intended to summarize the current knowledge from basic science and clinical medical literature cited within PubMed that pertain to gender-related factors and affect those individuals with hereditary ocular disorders. We consider gender-related biological factors that (a) affect disease onset and progression, (b) gender differences for major X-linked ocular disorders, (c) gender-specific conditions, (d) medications that may influence genetic eye disorders, and finally, (e) gender-related issues that influence the management and quality of life of these patients. Several studies have demonstrated the manner in which sex-related hormones in animal models are capable of influencing cell pathway and survival that are likely to affect hereditary eye disorders. There are very few clinical studies that provide compelling evidence for gender differences in human ocular conditions, other than for a number of X-linked disorders. Disease expression for X-linked disorders may be impacted by genetic mechanisms such as lyonization or uniparental disomy. Clinical evidence regarding the impact of gender-related medical conditions and therapies on eye conditions is extremely limited and primarily based on anecdotal evidence. Gender-specific factors may play a major role in the underlying biological pathways that influence the onset, rate of progression, and clinical findings associated with ocular genetic conditions. Clinicians need to be aware of the variable phenotypes observed in female carriers of X-linked disorders of gender specific issues, many of which are inadequately addressed in the current literature. Clinicians need to be sensitive to gender differences in social, cultural, and religious systems and they should also be aware of how their own gender biases may influence how they counsel patients. Finally, it is clear that the lack of effective clinical studies in this area creates an opportunity for future research that will have real benefits for these patients.

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Postpartum aortic dissection

Cited by 28 publications

References 25 publications

Marfan Syndrome Versus Bicuspid Aortic Valve Disease: Comparative Analysis of Obstetric Outcome and Pregnancy-Associated Immediate and Long-Term Aortic Complications

Marfan Syndrome Versus Bicuspid Aortic Valve Disease: Comparative Analysis of Obstetric Outcome and Pregnancy-Associated Immediate and Long-Term Aortic Complications

At the Heart of the Pregnancy: What Prenatal and Cardiovascular Genetic Counselors Need to Know about Maternal Heart Disease

Gender Specific Issues in Hereditary Ocular Disorders

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