Aortic Dissection Risk in Pregnancy With Marfan Syndrome

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Two cases of postpartum aortic dissection occurred: one type A and one type B.
Two cases of postpartum aortic dissection occurred: one type A and one type B.

HealthDay News – Pregnant patients with Marfan syndrome, particularly those with a dilating aortic root, are at high risk of aortic dissection during and following pregnancy, according to a study published in The American Journal of Cardiology.

Rafael Kuperstein, MD, from the Sheba Medical Center in Tel Hashomer, Israel, and colleagues examined the risk for aortic dissection and pregnancy outcome in patients with Marfan syndrome. Women were offered beta-blockers, which were titrated by blood pressure and heart rate. Patients with aortic root dilation of ≥40 mm were considered high risk. Thirty-one pregnancies in 19 women with Marfan syndrome were followed.

The researchers found that 8 pregnancies occurred in patients with a dilated aortic root; beta-blocker treatment was used by 21 patients. Two cases of postpartum aortic dissection occurred (6.5%): one type A dissection in a patient with a dilated aortic root who declined beta-blockers and one type B dissection. There was a significant association for increasing aortic root diameter with later aortic dissection (2 of 6 vs 0 of 21; P =.04). There were no maternal deaths. High-risk women with Marfan syndrome gave birth by cesarean section, while the mode of delivery was obstetric indication in the non-high-risk group.

"Pregnant patients with Marfan syndrome, especially those with a dilating aortic root, are at high risk of aortic dissection, even with tight control of blood pressure and heart rate," the authors wrote.

Reference

Kuperstein R, Cahan T, Yoeli-Ullman R, Zekry SB, Shinfeld A, Simchen MJ. Risk of aortic dissection in pregnant patients with the Marfan syndrome. J Am Cardiol. 2017;119(1):132-137. doi:10.1016/j.amjcard.2016.09.024.

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