Document Type : Case Report
Authors
1 Assistant Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute AND Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Department of Obstetrics and Gynecology, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
3 Assistant Professor, Department of Cardiology, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
4 General Practitioner, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
5 General Practitioner, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: The most dramatic diseases in the aorta are aortic dissection and aneurysm, which both of them are common in pregnant women with Marfan syndrome (MFS). According to recommendations in existing guidelines, pregnancy is not recommended in patients with severe dilation of the aorta and patients with MFS with aortic dilation > 45 mm should have prophylactic aortic repair before pregnancy.CASE REPORT: In this rare and unique report, we described a 34-year-old pregnant woman with marfanoid feature who had an approximate aortic root of 60 mm and severe aortic insufficiency. She denied terminating the pregnancy at her first prenatal visit and continued it until 30 weeks of gestation and the pregnancy terminated in the cardiac operating room due to multiple episodes of chest pain. No complication occurred during her close observation before surgery. The aortic repair was performed for her after the cesarean section.CONCLUSION: Pregnancy with severe aortic root dilation is high-risk for all patients; however, if it occurs, when the mother denies an abortion, inform the patient about its risk and continue the pregnancy with close observation and tight blood pressure (BP) control until the fetus becomes viable.
Keywords
- Judge DP, Dietz HC. Marfan's syndrome. Lancet 2005; 366(9501): 1965-76.
- Baumgartner H, Bonhoeffer P, De Groot NM, de HF, Deanfield JE, Galie N, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31(23): 2915-57.
- Houston L, Tuuli M, Macones G. Marfan syndrome and aortic dissection in pregnancy. Obstet Gynecol 2011; 117(4): 956-60.
- Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: The task force on the management of cardiovascular diseases during pregnancy of the European society of cardiology (ESC). Eur Heart J 2011; 32(24):
- -97.
- Smith K, Gros B. Pregnancy-related acute aortic dissection in Marfan syndrome: A review of the literature. Congenit Heart Dis 2017; 12(3): 251-60.
- Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomstrom-Lundqvist C, Cifkova R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39(34): 3165-241.
)