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Narula N, Devereux RB, Malonga GP, Hriljac I, Roman MJ. Pregnancy-Related Aortic Complications in Women With Marfan Syndrome. J Am Coll Cardiol 2021; 78:870-879. [PMID: 34446158 DOI: 10.1016/j.jacc.2021.06.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND The risk of pregnancy-associated vascular complications in Marfan syndrome (MFS) is uncertain because of ascertainment bias, prepartum lack of knowledge of diagnosis, and insufficient peripartum imaging data. Furthermore, U.S. and European guidelines differ in pregnancy recommendations in MFS. OBJECTIVES This study describes a single-center experience of 169 MFS women to address these gaps. METHODS Clinical, imaging, and pregnancy history were compared in never vs ever-pregnant MFS women, and pregnancy-associated vascular complications were described. RESULTS A total of 74 ever-pregnant women had 112 live births. Elective aortic root replacement occurred at a younger age in never-pregnant women (33 years vs 42 years; P = 0.0026). Although aortic dissection prevalence did not differ between never-pregnant vs ever-pregnant women (23% vs 31%; P = 0.25), it tended to occur at an earlier age in the former group (38 years vs 45 years; P = 0.07). Of observed "sanctioned" pregnancies with prepartum diameters ≤4.5 cm, mean pregnancy-related aortic diameters remained stable. In total, 5 dissections were associated with pregnancy: 2 type A in women unaware of their diagnosis; and 2 type B and 1 isolated coronary artery dissection in women aware of their diagnosis. Dissection rates were 5-fold higher in the pregnancy vs nonpregnancy period. CONCLUSIONS Pregnancy-related type A dissection only occurred in patients unaware of their diagnosis. Type B dissection remains an unpredictable complication. Although there were baseline differences between the never- and ever-pregnant groups, no difference in dissection risk was observed outside the peripartum period. Those with prepartum aortic diameters between 4.0 and 4.5 cm demonstrated stable aortic dimensions throughout pregnancy. These findings provide a rationale to update existing U.S. guidelines for the management of pregnancy in MFS.
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Affiliation(s)
- Nupoor Narula
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA. https://twitter.com/DrNupoorNarula
| | | | - Grace P Malonga
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Ingrid Hriljac
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA.
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Roman MJ, Pugh NL, Hendershot TP, Devereux RB, Dietz H, Holmes K, Eagle KA, LeMaire SA, Milewicz DM, Morris SA, Pyeritz RE, Ravekes WJ, Shohet RV, Silberbach M. Aortic Complications Associated With Pregnancy in Marfan Syndrome: The NHLBI National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). J Am Heart Assoc 2016; 5:JAHA.116.004052. [PMID: 27515814 PMCID: PMC5015314 DOI: 10.1161/jaha.116.004052] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The risk of aortic complications associated with pregnancy in women with Marfan syndrome (MFS) is not fully understood. METHODS AND RESULTS MFS women participating in the large National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) were evaluated. Among 184 women with MFS in whom pregnancy information was available, 94 (51%) had a total of 227 pregnancies. Among the women with pregnancies, 10 (10.6%) experienced a pregnancy-related aortic complication (4 type A and 3 type B dissections, 1 coronary artery dissection, and 2 with significant [≥3 mm] aortic growth). Five of 7 aortic dissections, including all 3 type B, and the coronary dissection (75% of all dissections) occurred in the postpartum period. Only 5 of 8 women with pregnancy-associated dissection were aware of their MFS diagnosis. The rate of aortic dissection was higher during the pregnancy and postpartum period (5.4 per 100 person-years vs 0.6 per 100 person-years of nonpregnancy; rate ratio, 8.4 [95% CI=3.9, 18.4]; P<0.0001). CONCLUSIONS Pregnancy in MFS is associated with an increased risk of aortic dissection, both types A and B, particularly in the immediate postpartum period. Lack of knowledge of underlying MFS diagnosis before aortic dissection is a major contributing factor. These findings underscore the need for early diagnosis, prepregnancy risk counseling, and multidisciplinary peripartum management.
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Affiliation(s)
- Mary J Roman
- Division of Cardiology, Weill Cornell Medical College, New York, NY
| | - Norma L Pugh
- Biostatistics and Epidemiology Division, RTI International, Rockville, MD
| | | | | | - Hal Dietz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathryn Holmes
- Department of Pediatrics, Oregon Health & Sciences University, Portland, OR
| | - Kim A Eagle
- Division of Cardiology, University of Michigan Health System, Ann Arbor, MI
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | - Shaine A Morris
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Reed E Pyeritz
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - William J Ravekes
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ralph V Shohet
- Department of Medicine, John A. Burns School of Medicine, Honolulu, HI
| | - Michael Silberbach
- Department of Pediatrics, Oregon Health & Sciences University, Portland, OR
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Abstract
Aortopathies, or disease affecting the aorta, are associated with a significant mortality risk for the mother and foetus during pregnancy because of an increased rate of aortic dissection. The hereditary aortopathies; Marfan's syndrome, bicuspid aortic valve, Loeys-Dietz syndrome, Ehlers-Danlos (type IV) syndrome, Turner's syndrome and nonsyndromic familial thoracic aortic aneurysm and dissection are all associated with an increased risk of aortic dissection particularly during the third trimester and early postpartum period. Maternal outcome in pregnancy depends on the underlying disorder and the aortic dimensions prior to pregnancy. The foetus has up to 50% chance of inheriting the underlying genetic defect. Vasculitis, particularly Takayasu's arteritis may also be a problem in pregnancy and predispose to aortic dissection. Prepregnancy review, including careful assessment of the aorta and prophylactic aortic surgery for an aortic aneurysm may reduce the risk of aortic dissection in pregnancy for some of the aortopathies but for women with Marfan's syndrome, Loeys-Dietz syndrome and Ehlers-Danlos (vascular type IV) who have had surgery, the risk of death remains high. A subgroup of women with Marfan's syndrome or a bicuspid aortic valve and normal aortic dimensions prepregnancy should do well in a pregnancy. Multidisciplinary pregnancy care with agreement on pregnancy follow-up, delivery and postpartum care with a crisis plan for an aortic dissection can improve pregnancy outcome and ensure prompt management of an aortic dissection should it occur.
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Affiliation(s)
- Fiona M Stewart
- Greenlane Cardiovascular Service and National Women's Health, Auckland City Hospital, Auckland, New Zealand
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Yuan SM. Aortic dissection during pregnancy: a difficult clinical scenario. Clin Cardiol 2013; 36:576-84. [PMID: 23843107 DOI: 10.1002/clc.22165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/23/2013] [Indexed: 02/02/2023] Open
Abstract
Aortic dissection (AoD) during pregnancy is a rare but lethal condition and highlights the need for extensive elucidation. The aim of this study is to reveal the risk factors for AoD during pregnancy and to compare the 2 main risk factors, Marfan syndrome and pregnancy itself in the previously healthy woman. The pregnant patients developed AoD at 31.7 ± 7.6 weeks of gestation. It occurred much earlier in the Marfan patients than in the previously healthy women (30.7 ± 8.6 weeks of gestation vs 34.4 ± 4.4 weeks of gestation, P = 0.0263). In the Marfan patients, AoD developed in 3 (3.2%), 15 (15.8%), and 43 (46.3%) patients in the 3 trimesters, respectively, compared with 31 of the previously healthy women, and only in the third trimester. The neonates of the Marfan patients had better Apgar scores at 1 and 5 minutes, lower intubation rates, and fewer stays in the neonatal intensive care unit than those of the previously healthy women. Marfan syndrome and pregnancy itself in the previously healthy woman were the 2 main risk factors responsible for the occurrence of AoD during pregnancy. Marfan patients may develop AoD at an early age and an early stage of pregnancy, probably due to the preexisting weakened aortic wall. Better outcomes for the surviving neonates of Marfan patients compared with neonates of the previously healthy women might be the result of the poor condition of Marfan patients causing a higher death rate for those fetuses.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, China
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Nishino H, Suda K, Kuramaoto A, Honda Y, Takemiya K, Ishii H, Kishimoto S, Iemura M, Hori D. Stanford type B aortic dissection associated with pregnancy in patients with Marfan syndrome-A case report and review of the literature. J Cardiol Cases 2010; 1:e180-e183. [PMID: 30524533 DOI: 10.1016/j.jccase.2009.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 11/28/2009] [Accepted: 12/18/2009] [Indexed: 11/30/2022] Open
Abstract
A 36-year-old female patient known to have Marfan syndrome (MFS) presented with Stanford type B aortic dissection (type B-AD) 3 days after delivery although she had taken oral β-blocker and underwent prophylactic cesarean section at 34 weeks when she showed 42 mm of the ascending aorta. She was successfully treated medically without further progression of the dissection. A review of the literature revealed an additional 19 patients with MFS who suffered from type B-AD associated with pregnancy. Of 20 patients, 1 (5%) died but the remaining 19 patients were successfully treated either medically (n = 9) or surgically (n = 10). Of 13 patients whose aortic diameter was known, 5 showed <40 mm of the ascending aorta. Pregnancy in MFS can be complicated by type B-AD with a peak around term delivery irrespective of the size of ascending aorta and even with β-blocker.
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Affiliation(s)
- Hiroshi Nishino
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume City, Japan
| | - Kenji Suda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume City, Japan
| | - Akitaka Kuramaoto
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume City, Japan
| | - Yoshihiro Honda
- Department of Cardiovascular Medicine, Kurume University School of Medicine, Kurume City, Japan
| | - Kiyoko Takemiya
- Department of Cardiovascular Medicine, Kurume University School of Medicine, Kurume City, Japan
| | - Haruka Ishii
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume City, Japan
| | - Shintaro Kishimoto
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume City, Japan
| | - Motofumi Iemura
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume City, Japan
| | - Daizo Hori
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume City, Japan
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Maternal complication of pregnancy in Marfan syndrome. Int J Cardiol 2009; 136:156-61. [DOI: 10.1016/j.ijcard.2008.04.035] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 04/14/2008] [Accepted: 04/23/2008] [Indexed: 11/24/2022]
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Volach V, Elami A, Gilon D, Pollak A, Ginosar Y, Ezra Y. Pregnancy in Marfan Syndrome after Aortic Root Replacement: A Case Report and Review of the Literature. CONGENIT HEART DIS 2006; 1:184-8. [DOI: 10.1111/j.1747-0803.2006.00032.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Marfan's Syndrome (MFS) is an autosomal dominant condition resulting in a generalised weakness of the supporting tissues of the body. In its classical form it is associated with abnormalities of the eye, the skeletal system and the cardiovascular system. The prevalence of classical Marfan's Syndrome is 4-6 per 100,000 people. It has significant implications for affected women who are contemplating pregnancy. A multidisciplinary approach involving the specialities of maternal fetal medicine, cardiology and clinical genetics is optimal for provision of care to women with Marfan's Syndrome.
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Affiliation(s)
- S Lalchandani
- Department of Minimal Access Surgery, Obstetrics and Gynaecology, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, East Yorkshire, UK.
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Velez LLN, Toal K, Goodwin SA. Two Lives on the Line: A Case Study in Obstetric Critical Care. Crit Care Nurse 2002. [DOI: 10.4037/ccn2002.22.6.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Laura Lee Naylor Velez
- Laura Velez is a graduate student at the University of Oklahoma in the acute care clinical nurse specialist track. She practices as a critical care nurse clinician at Norman Regional Hospital, Norman, Okla
| | - Kyle Toal
- Kyle Toal is a cardiovascular surgeon in private practice in Norman, Okla. He completed his medical training at the University of Oklahoma and is board certified in general vascular and thoracic surgery
| | - Susan A. Goodwin
- Susan A. Goodwin is a clinical nurse specialist with a specialization in perianesthesia nursing. She is a nurse manager at the Surgery Center of Edmond in Edmond, Okla
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Brar HB. Anaesthetic management of a caesarean section in a patient with Marfan's syndrome and aortic dissection. Anaesth Intensive Care 2001; 29:67-70. [PMID: 11261916 DOI: 10.1177/0310057x0102900114] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This report describes a case of a Stanford Type B aortic dissection (originating distal to the left subclavian artery and extending to the aortic bifurcation and proximal left iliac artery) in a 31-year-old primigravid woman who was at 39 weeks gestation and had Marfan's syndrome. The dissection was managed conservatively. Caesarean section was performed under epidural anaesthesia with aggressive control of hypertension. Postoperatively, there was no extension of the dissection and no aneurysm formation. She was discharged from hospital two weeks after delivery and remained asymptomatic at six months. There are no plans for surgical intervention.
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Affiliation(s)
- H B Brar
- Department of Anaesthesia, Monash Medical Centre, Melbourne, Victoria
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Lipscomb KJ, Smith JC, Clarke B, Donnai P, Harris R. Outcome of pregnancy in women with Marfan's syndrome. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:201-6. [PMID: 9070139 DOI: 10.1111/j.1471-0528.1997.tb11045.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To improve life expectancy and prevent premature mortality in women with Marfan's syndrome. METHODS During the development of a regional genetic register for Marfan's Syndrome the outcome of 91 pregnancies in 36 women with this condition was established retrospectively and the cardiovascular and obstetric complications documented. RESULTS No patient had a significant cardiovascular abnormality limiting function before her pregnancy. Of 36 women, four had an aortic dissection relating to pregnancy and two others required aortic surgery following delivery. Thirty women had uncomplicated gestational histories. The incidence of obstetric complications did not exceed expectation. CONCLUSIONS Women with Marfan's syndrome are at significant risk of aortic dissection in pregnancy even in the absence of preconceptional cardiovascular abnormality. Aortic root dilatation may be a predictor of risk but dissection may occur without significant dilatation. Guidelines for obstetric care are suggested and preconceptional assessment recommended.
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Affiliation(s)
- K J Lipscomb
- University Department of Cardiology, Manchester Heart Center, Manchester Royal Infirmary, UK
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Llopis JE, Garcia-Aguado R, Sifre C, Rosso MT, Vivó M, Martin-Jurado J, Grau F. Total intravenous anaesthesia for caesarean section in a patient with Marfan's syndrome. Int J Obstet Anesth 1997; 6:59-62. [PMID: 15321314 DOI: 10.1016/s0959-289x(97)80055-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The case is described of a pregnant patient with Marfan's syndrome scheduled at 39 weeks' gestation for elective caesarean section carried out for the first time by total intravenous anaesthesia (TIVA) with continuous intravenous (i.v.) infusion of propofol. The diagnosis was based on a positive family history, classic phenotype, scoliosis, arachnodactyly, high narrow palate, hyperextensible joints, ectopia lentis and mitral valve prolapse, with a secondary low mitral insufficiency. Maternal and fetal surveillance did not detect complications during the course of pregnancy. Elective caesarean section was performed at 39 weeks due to high-risk pregnancy and to avoid the risk of haemodynamic alterations that take place during labour and delivery. The patient was given general anaesthesia with continuous i.v. infusion of propofol and boluses of atracurium and fentanyl after delivery. The haemodynamics and oxygen saturation remained stable during surgery. Apgar scores were 9 at 1 and 5 min. The post-delivery course was unremarkable and post partum echocardiography showed no changes from before caesarean section. The cardiovascular problems of Marfan's syndrome, the risk of haemodynamic changes associated with pregnancy and delivery, its anaesthetic implications and the possible advantages of TIVA with continuous i.v. infusion of propofol in the anaesthetic management of caesarean section in patients with this disease are discussed.
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Affiliation(s)
- J E Llopis
- Department of Anaesthesia, Critical Care and Pain Relief, Valencia University General Hospital, Valencia, Spain
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Rossiter JP, Repke JT, Morales AJ, Murphy EA, Pyeritz RE. A prospective longitudinal evaluation of pregnancy in the Marfan syndrome. Am J Obstet Gynecol 1995; 173:1599-606. [PMID: 7503207 DOI: 10.1016/0002-9378(95)90655-x] [Citation(s) in RCA: 239] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We undertook a prospective evaluation of the outcomes of pregnancy, both maternal and fetal, and the long-term impact of pregnancy on Marfan syndrome in a series of consecutive, unselected patients. STUDY DESIGN Forty-five pregnancies in 21 Marfan syndrome patients were prospectively observed in one institution between 1983 and 1992. During pregnancy, patients were monitored with serial echocardiograms and close attention to symptoms. Maternal and fetal outcomes were monitored with serial echocardiographic data were analyzed by least-squares regression. Eighteen of the patients were followed up for 15 months to 13 years after the completion of their last pregnancy for investigation of the long-term impact of pregnancy on the cardiovascular manifestations of Marfan syndrome. RESULTS Aortic dissection occurred in two patients, both with increased risk for dissection established before pregnancy. The incidence of obstetric complications otherwise did not exceed that in the general population. Echocardiographic data demonstrated little to no change in aortic root diameter throughout pregnancy in most patients. Long-term follow-up showed no apparent worsening of cardiovascular status attributable to pregnancy in comparison with a group of 18 women with Marfan syndrome who were of similar age, had a similar degree of disease severity, and underwent no pregnancies. CONCLUSIONS Patients with Marfan syndrome in whom cardiovascular involvement is minor and aortic root diameter is < 40 mm usually tolerate pregnancy well, with favorable maternal and fetal outcomes, and without subsequent evidence of aggravated aortic root dilatation over time.
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Affiliation(s)
- J P Rossiter
- Center for Medical Genetics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Abstract
Two patients with Marfan syndrome who presented for labor and delivery are reviewed. The characteristics of Marfan syndrome and their significance in relation to the physiologic changes due to pregnancy and the implications for anesthetic management are discussed. Marfan syndrome can present with musculoskeletal, cardiovascular, ocular, and pulmonary complications believed to be secondary to an inheritable disorder of connective tissue metabolism. These patients must be carefully evaluated, monitored, and managed during the prepartum and peripartum period. The physiology of pregnancy, particularly the hemodynamic changes, can have catastrophic consequences for the parturient with Marfan syndrome. Serial echocardiographic studies evaluating aortic root size and aortic and mitral valve function are essential during pregnancy. Anesthetic management focuses on minimizing aortic root shear forces and wall stress through invasive monitoring, pharmacologic intervention, and pain treatment.
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Affiliation(s)
- C F Gordon
- Department of Anesthesia, Brigham and Women's Hospital, Boston, MA
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Affiliation(s)
- J L Carson
- Department of Medicine, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, New Brunswick 08903
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Boxer RA, LaCorte MA, Singh S, Davis J, Goldman M, Stein HL. Evaluation of the aorta in the Marfan syndrome by magnetic resonance imaging. Am Heart J 1986; 111:1001-2. [PMID: 3706100 DOI: 10.1016/0002-8703(86)90657-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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LIMACHER MARIANC. Echocardiography in Pregnancy. Echocardiography 1986. [DOI: 10.1111/j.1540-8175.1986.tb00181.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lind J, Hoynck van Papendrecht HP. Obstetrical complications in a patient with the Marfan syndrome. Eur J Obstet Gynecol Reprod Biol 1984; 18:161-8. [PMID: 6500157 DOI: 10.1016/0028-2243(84)90015-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case history of a pregnant patient with the Marfan syndrome is presented. During pregnancy regular echocardiographic examinations were performed, showing a slight increase in the aortic root diameter 1 month after delivery. The hydroxyproline content of the amniotic fluid appeared to be significantly elevated; however, the baby did not seem to be affected by the Marfan syndrome. After delivery we noted a recto-vaginal perforation, which has not been described in deliveries of Marfan patients before. Pregnancy in a Marfan patient is a hazardous situation, with a 10-40% fatal outcome according to the literature. Regular echocardiographic control is necessary to evaluate the cardiac risk.
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