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Gong JN, Mao JJ, Kuang TG, Yang SQ, Li JF, Wang JF, Huang Q, Miao R, Guo XJ, Li YD, Yang YH. Analysis of clinical features between active and inactive patients of Takayasu's arteritis with pulmonary arteries involvement. Int J Cardiol 2023; 381:88-93. [PMID: 36914072 DOI: 10.1016/j.ijcard.2023.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/11/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND The aim of this study was to investigate the clinical characteristics of patients between active and inactive Takayasu's arteritis with pulmonary artery involvement (PTA) and to identify better markers of disease activity in these patients. METHODS Sixty-four PTA patients in Beijing Chao-yang hospital (2011 to 2021) were included. According to National Institutes of Health criteria, 29 patients were in active stage and 35 were in inactive stage. Their medical records were collected and analyzed. RESULTS Compared with inactive group, patients in active group were younger. More patients in active stage presented fever (41.38% vs 5.71%), chest pain (55.17% vs 20%), increased C-reactive protein (2.91 vs 0.46 mg/L), erythrocyte sedimentation rate (35.0 vs 9 mm/h), and platelet count (291 vs 221 × 109/L). Pulmonary artery wall thickening was more common in active group (51.72% vs 11.43%). These parameters were restored after treatment. The incidence of pulmonary hypertension was comparable between groups (34.48% vs 51.43%), but patients in active group had lower pulmonary vascular resistance (PVR) (361.0 vs 891.0 dyn·s·cm-5) and higher cardiac index (2.76 ± 0.72 vs 2.01 ± 0.58 L/min/m2). On multivariate logistic regression analysis, chest pain [odds ratio (OR) 9.37, 95%CI (1.98-44.38), P = 0.005], increased platelet count (>242.5 × 109/L) [OR 9.03, 95%CI (2.10-38.87), P = 0.003] and pulmonary artery wall thickening [OR 7.08, 95%CI (1.44-34.89), P = 0.016] were independently associated with disease activity. CONCLUSION Chest pain, increased platelet count, and pulmonary artery wall thickening are potential new indicators of disease activity in PTA. Patients in active stage may have lower PVR and better right heart function.
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Affiliation(s)
- Juan-Ni Gong
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Jian-Jun Mao
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Tu-Guang Kuang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Su-Qiao Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Ji-Feng Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Jian-Feng Wang
- Department of Interventional Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Qiang Huang
- Department of Respiratory and Critical Care Medicine, China-Japan friendship Hospital, Beijing 100020, PR China
| | - Ran Miao
- Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China.; Department of Basic Laboratory, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Xiao-Juan Guo
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Yi-Dan Li
- Department of Ultrasonography, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Yuan-Hua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China; Beijing Institute of Respiratory Medicine, Beijing 100020, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China..
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2
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Alobo G, Nahurira V, Omona V, Bayo P, Olum S. Refractory convulsive syncope in pregnancy: a rare presentation of Takayasu's arteritis - a case report and literature review. Afr Health Sci 2021; 21:852-857. [PMID: 34795744 PMCID: PMC8568231 DOI: 10.4314/ahs.v21i2.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neurological manifestation of Takayasu's Arteritis (TA) in pregnancy presenting as convulsive syncope is extremely rare, and poses a serious diagnostic dilemma due to other vast causes of fits in pregnancy. OBJECTIVE We aimed to present and shed more light on a case of TA with convulsive syncope in pregnancy refractory to anticonvulsants for seven weeks, and review the literature on the management of TA in pregnancy. CASE PRESENTATION A gravida 4 para 3+0 at 28 weeks of amenorrhea presented with repeated episodes of the sudden loss of consciousness, followed by a fall and jerking of the limbs. These were refractory to anticonvulsants that she had used for seven weeks. Physical examination revealed undetectable pulse and blood pressure (BP) in the upper limbs but elevated BP in the lower limbs. Further investigations confirmed TA and she improved on steroids and antihypertensives. CONCLUSION This case typically describes the unexpected presentation of TA with convulsive syncope. It calls for meticulous clinical assessment of epileptic seizures in pregnancy to avoid a late diagnosis of TA and its potential poor outcomes.
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Affiliation(s)
- Gasthony Alobo
- Department of Obstetrics and Gynecology, Lacor Hospital, Gulu, Uganda
- Department of Obstetrics and Gynecology, Lira University, Lira Uganda
| | - Violah Nahurira
- Department of Obstetrics and Gynecology, Lacor Hospital, Gulu, Uganda
| | - Venice Omona
- Department of Pediatrics and Neurology, Lacor Hospital, Gulu, Uganda
| | - Pontius Bayo
- Department of Obstetrics and Gynecology, Lacor Hospital, Gulu, Uganda
| | - Sam Olum
- Department of Internal Medicine, Gulu University, Gulu, Uganda
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3
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Meng X, Han J, Wang L, Wu Q. Aortic dissection during pregnancy and postpartum. J Card Surg 2021; 36:2510-2517. [PMID: 33928681 DOI: 10.1111/jocs.15575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/21/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with aortic dissection during pregnancy and postpartum period exhibit a high mortality. At present, a complete overview of aortic dissection during pregnancy and postpartum period is lacking. Methods: This systematic review included 80 reports published from 2000 to 2020, comprising a total study population of 103 patients with aortic dissection. Results: We found that Stanford Type A aortic dissection was more common in prepartum cases, especially in the third trimester, while postpartum cases of aortic dissection were more common in Stanford Type B. The most common risk factor was connective tissue disease, with no other known risk factors. The mode of delivery had no significant effect on the type of postpartum aortic dissection. Reduced maternal and fetal mortality was observed when patients with Stanford Type A aortic dissection occurring after 28 gestational weeks underwent cesarean section followed by aortic replacement. Patients with Stanford Type B aortic dissection were treated mainly with medication and/or endovascular repair. Conclusion: Contemporary management of patients during pregnancy and within 12 weeks postpartum requires multidisciplinary cooperation and includes serial, noninvasive imaging, biomarker testing, and genetic risk profiling for aortopathy. Early diagnosis and accurate treatment are essential to reduce maternal and fetal mortality.
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Affiliation(s)
- Xiangli Meng
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jijing Han
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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4
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Mazumdar E, White RD, Williams IM. Takayasu's arteritis and acute type B aortic dissection treated with a stent graft. Vascular 2020; 29:657-660. [PMID: 33270524 DOI: 10.1177/1708538120971988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Takayasu's arteritis is a large vessel vasculitis which usually involves the aorta and its first generation branches. Aortic dissection, however, is a rare manifestation of Takayasu's arteritis and for this reason optimum management in both short and long term is unknown. METHODS This is a case of a 31-year-old female presenting with acute type B AD in association with underlying TA which failed to respond to conservative management and underwent thoracic stent grafting (TEVAR). RESULTS Despite successful coverage of the intimal breach in the thoracic aorta by TEVAR there were complications with delivery of the stent which required a conduit sutured to the right common iliac artery. Also post-TEVAR computed tomography showed a localised dissection of the origin of the left common carotid artery which may have been iatrogenic possibly due to the stiff guidewire used during delivery of the stent graft to the thoracic aorta. CONCLUSIONS The use of TEVAR for an acute type B AD in those with TA may be problematic. The fragility of the major arteries increases the likelihood of iatrogenic periprocedural complications and long-term surveillance is essential due to significant chance of further arterial complications in type B AD occurring in TA.
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Affiliation(s)
- E Mazumdar
- Department of Vascular Surgery, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - R D White
- Department of Radiology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - I M Williams
- Department of Vascular Surgery, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
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Comarmond C, Saadoun D, Nizard J, Cacoub P. Pregnancy issues in Takayasu arteritis. Semin Arthritis Rheum 2020; 50:911-914. [PMID: 32911287 DOI: 10.1016/j.semarthrit.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Takayasu arteritis (TAK) is a chronic inflammatory vasculitis of unknown origin affecting large vessels, predominantly the aorta and its main branches. TAK usually affects young women and the management of pregnancy during this vasculitis may be a challenging situation. After a review of the literature, we analysed the data of 505 pregnancies in 373 TAK patients. We discuss main results to clarify if the pregnancy outcome is affected by TAK, especially during disease clinical onset or disease activity. We also discuss the potential impact of pregnancy on TAK prognosis. Disease activity of TAK appears independently associated with a poor pregnancy outcome. More than 5% of pregnant women with TAK develop a life-threatening maternal cardiovascular complication. A good control of TAK disease activity and arterial hypertension before conception and during pregnancy is critical to improve both maternal and foetal outcomes. Pregnancies in the setting of TAK should be considered high-risk, requiring a close collaboration between specialists involved in the care of TAK and obstetricians.
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Affiliation(s)
- Cloe Comarmond
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière.
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière
| | - Jacky Nizard
- Department of gynaecology and obstetrics, Groupe Hospitalier Pitié-Salpêtrière, CNRS UMR 7222, INSERM U1150, Sorbonne Universités, Paris, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière.
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6
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David LS, Beck MM, Kumar M, Rajan SJ, Danda D, Vijayaselvi R. Obstetric and perinatal outcomes in pregnant women with Takayasu’s arteritis: single centre experience over five years. J Turk Ger Gynecol Assoc 2020; 21:15-23. [PMID: 31564080 PMCID: PMC7075400 DOI: 10.4274/jtgga.galenos.2019.2019.0115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/22/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To study obstetric and perinatal outcomes among pregnant women with Takayasu arteritis (TA), attending our hospital for pregnancy and childbirth between January 2011 to December 2016. Material and Methods Retrospective study was carried out by abstracting clinical charts on all pregnant women with TA who underwent antenatal care and/or delivery in our hospital during this period. American College of Rheumatology criteria was used for diagnosis of TA. Sixteen women with TA were included in the study. Maternal demographic data, stage of disease, complications related to disease, details of treatment taken prior to pregnancy, pregnancy outcomes, and neonatal outcomes were studied. Results Forty-four percentage (7/16) belonged to type 5 angiographic type, however the same proportion (7/16) had undergone surgical corrections prior to pregnancy and the majority (15/16) were on medical management. Only three women (19%) were diagnosed during pregnancy. Most did not have active disease measured by Kerr’s criteria (n=12; 75%), and Indıan Takayasu clinical activity scores A. Chronic hypertension was the commonest antenatal complication (56.2%), nearly one-third had growth restricted babies and 25% had preterm labour. There were no cardiovascular events, no maternal deaths, nor fetal or neonatal deaths. Two-thirds of our women were delivered by caesarean section. Conclusion Preconceptional counselling is of paramount importance in women with TA. Good maternal and fetal outcomes are observed with close antenatal surveillance and multidisciplinary care. Pregnancy should be planned during disease remission, with good antenatal care, close monitoring of clinical symptoms, early diagnosis and treatment of complications.
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Affiliation(s)
- Liji Sarah David
- Clinic of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
| | - Manisha Madhai Beck
- Clinic of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
| | - Manish Kumar
- Clinic of Neonatology, Christian Medical College and Hospital, Vellore, India
| | - Sudha Jasmine Rajan
- Clinic of Obstetric Medicine, Christian Medical College and Hospital, Vellore, India
| | - Debashish Danda
- Clinic of Rheumatology, Christian Medical College and Hospital, Vellore, India
| | - Reeta Vijayaselvi
- Clinic of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
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7
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Kikuchi Y, Kuroda M, Saito S. Anesthetic Management of Emergency Cesarean Delivery Followed Immediately by Thoracic Endovascular Aortic Repair for a Peripartum Dissecting Aorta Aneurysm With Impending Rupture (Stanford Type B Dissection) in a Pregnant Patient With Takayasu's Arteritis. J Cardiothorac Vasc Anesth 2020; 34:1897-1901. [PMID: 31937478 DOI: 10.1053/j.jvca.2019.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Yuki Kikuchi
- Department of Anesthesia, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
| | - Masataka Kuroda
- Department of Anesthesia, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
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8
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Bharuthram N, Tikly M. Pregnancy and Takayasu arteritis: case-based review. Rheumatol Int 2019; 40:799-809. [PMID: 31858208 DOI: 10.1007/s00296-019-04499-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022]
Abstract
Takayasu arteritis (TA) is a rare large vessel vasculitis that particularly affects women of child-bearing age. Management of pregnant patients with TA is often challenging due to the cardiovascular and cerebrovascular complications of the disease. We report two new cases of pregnancy in patients with TA and review all published cases from sub-Saharan Africa. Analysis of 16 pregnancies in 15 patients (including our two cases) showed that seven patients had radiographic Type V TA disease, namely involvement of the entire length of the aorta. Four patients were newly diagnosed with TA during pregnancy and two pregnancies were unbooked at time of first presentation. Seven pregnancies were complicated by disease flares (n = 4) and/or hypertension (n = 6). Four pregnancies resulted in preterm delivery and six required caesarean sections. There was one documented case of pre-eclampsia resulting in the only maternal death. Intrauterine growth restriction was documented in two of six pregnancies in which foetal ultrasonography was performed. There were four low birth weight infants and one fresh stillbirth (associated with the maternal death). In the handful of case reports of pregnancy in TA from sub-Saharan Africa, both maternal and foetal outcomes were generally good and similar to international findings. In a substantial proportion of patients, the diagnosis of TA was made in pregnancy, reflecting challenges of access to appropriate health care in resource constrained sub-Saharan Africa.
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Affiliation(s)
- Nirvana Bharuthram
- Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Mohammed Tikly
- Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Itani R, Elmallahi N, Ramadan MAA, Al Ibrahim A. Pregnancy with Takayasu's Arteritis: A Case Report and Literature Review. Cureus 2018; 10:e3370. [PMID: 30510880 PMCID: PMC6257600 DOI: 10.7759/cureus.3370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Takayasu's arteritis (TA) is a rare and chronic inflammatory disease of the large vessels. It affects women of reproductive age and leads to an increased risk of cardiovascular complications, such as hypertension and congestive heart failure. We are presenting a case of a pregnant woman with TA, who was seen and managed at a tertiary care institute and ultimately enjoyed a favorable outcome. Thus, multidisciplinary care for patients with TA has proven to be crucial in optimized and favorable maternal and fetal/neonatal outcomes.
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Affiliation(s)
- Rayan Itani
- Obstetrics and Gynecology, Women's Wellness and Research Center/ Hamad Medical Corporation, Doha, QAT
| | - Naela Elmallahi
- Obstetrics and Gynecology, Women's Wellness and Research Center/ Hamad Medical Corporation, Doha, QAT
| | | | - Abdullah Al Ibrahim
- Obstetrics and Gynecology, Women's Wellness and Research Center/ Hamad Medical Corporation, Doha , QAT
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10
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Smith K, Gros B. Pregnancy-related acute aortic dissection in Marfan syndrome: A review of the literature. CONGENIT HEART DIS 2017; 12:251-260. [PMID: 28371362 DOI: 10.1111/chd.12465] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 11/25/2022]
Abstract
A well-established association exists between acute aortic dissection and pregnancy, particularly in women with Marfan syndrome. However, there is debate regarding appropriate management guidelines. In particular, there are differing opinions regarding when prophylactic aortic root repair should be recommended as well as the efficacy of beta blockers in this clinical scenario. The current study evaluated 10 years of published literature (2005-2015) in the PubMed/Medline database. Fifty articles, describing 72 cases of women who presented with aortic dissection in the antepartum or postpartum period were identified. Comparisons on demographic variables and clinical outcomes between cases of women with Marfan syndrome (n = 36) and without Marfan syndrome (n = 36) were conducted. There were no significant differences in demographics (age, gravidity, parity) between the Marfan and non-Marfan cases. Marfan patients presented with antepartum dissections significantly earlier in pregnancy than those without Marfan syndrome (P = .002). However, there were no significant difference between the 2 groups in maternal mortality, fetal mortality, or obstetric outcomes (mode of delivery and gestational age at delivery). Eight cases described events in Marfan women with an aortic root diameter ≤40 mm. Six events occurred in Marfan women who were managed with beta blockers. Current guidelines rely on aortic root diameter for stratification of Marfan women into risk categories, but we identified several cases that would be missed by these guidelines. Specifically, the existing literature suggest that women with Marfan syndrome should take precautions throughout pregnancy, rather than the third trimester.
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Affiliation(s)
| | - Bernard Gros
- University of Central Florida College of Medicine
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11
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Yang KQ, Yang YK, Meng X, Zhang Y, Zhang HM, Wu HY, Liu YX, Jiang XJ, Cai J, Zhou XL, Hui RT, Zheng DY, Liu LS. Aortic Dissection in Takayasu Arteritis. Am J Med Sci 2017; 353:342-352. [DOI: 10.1016/j.amjms.2017.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/14/2017] [Accepted: 01/19/2017] [Indexed: 11/27/2022]
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Abstract
Vasculitis is more often a disease of women beyond their reproductive years, leaving the challenges of pregnancy management difficult to study. Pregnancy complications, including pregnancy loss and preterm birth, are higher among women with all forms of vasculitis. It seems that controlling the disease before pregnancy may improve the chances of pregnancy success. Many medications used for vasculitis are considered low risk in pregnancy, including prednisone, colchicine, azathioprine, and tumor necrosis factor inhibitors. Cyclophosphamide, methotrexate, and mycophenolate mofetil should be avoided in pregnancy. Controlling disease with low-risk medications may allow women with vasculitis to have the pregnancies they desire.
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13
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Jayet J, Gaudric J, Dennery M, Kagan N, Hié M, Khelifa I, Chiche L, Koskas F. Management of a Thoracic Aortic Aneurysm during Pregnancy Leading to the Diagnosis of Takayasu Arteritis. Ann Vasc Surg 2016; 36:291.e1-291.e4. [DOI: 10.1016/j.avsg.2016.02.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/29/2016] [Accepted: 02/29/2016] [Indexed: 11/26/2022]
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14
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Wang J, Lee YZ, Cheng Y, Zheng Y, Gao J, Tang X, Wang T, Zhang C. Sonographic Characterization of Arterial Dissections in Takayasu Arteritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1177-1191. [PMID: 27105948 DOI: 10.7863/ultra.15.07042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/02/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Takayasu arteritis is a relatively rare chronic nonspecific form of large-vessel vasculitis in which the involved vessels develop stenoses, occlusions, dilatations or aneurysms, and dissections. Dissections of the arteries in patients with Takayasu arteritis are not well understood. In this study, we explored the sonographic characterization of these rare complications secondary to Takayasu arteritis. METHODS We evaluated arterial dissections in 72 patients with a clinical diagnosis of Takayasu arteritis by vascular sonography and transthoracic echocardiography. We analyzed the dissection distribution and morphologic characteristics of the dissected intima/layer and lumen of the involved vessels. RESULTS Twelve of 72 patients had arterial dissections, in whom 16 dissected segments were identified. The involved arteries included the carotid, subclavian, vertebral, brachial, celiac, and femoral arteries, aortic arch, and abdominal aorta. The dissection lesions occurred at any age and coexisted with the aforementioned injuries. Evaluation of the dissected intima/layer and the involved lumen by sonography was technically complicated. The morphologic characteristics of the dissected intimae and involved lumens were complex, with most of the dissected intimae/layers having the characteristic "macaroni" sign in the arterial wall. High-frequency and high-resolution sonography, color Doppler flow imaging, and other techniques were useful in elucidating greater lesion details. CONCLUSIONS Arterial dissections in Takayasu arteritis can involve any anatomic vessel location and have complex morphologic characteristics. Sonography is the optimal technique for diagnosis and follow-up of patients with Takayasu arteritis and dissections.
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Affiliation(s)
- Jiong Wang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, ChinaDepartment of Radiology, University of North Carolina Hospital, Chapel Hill, North Carolina USADepartment of Medical Ultrasonography, Peking University International Hospital, Beijing, China
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina Hospital, Chapel Hill, North Carolina USA
| | - Yi Cheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ye Zheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Junyi Gao
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xiaobin Tang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Tian Wang
- Department of Rheumatology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Chun Zhang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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Comarmond C, Mirault T, Biard L, Nizard J, Lambert M, Wechsler B, Hachulla E, Chiche L, Koskas F, Gaudric J, Cluzel P, Messas E, Resche-Rigon M, Piette JC, Cacoub P, Saadoun D. Takayasu Arteritis and Pregnancy. Arthritis Rheumatol 2015; 67:3262-9. [DOI: 10.1002/art.39335] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/13/2015] [Indexed: 01/26/2023]
Affiliation(s)
- C. Comarmond
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Référence des Maladies Auto-Immunes et Systémiques Rares, and Université Pierre et Marie Curie, Paris 6; Paris France
| | - T. Mirault
- AP-HP, Hôpital Européen Georges-Pompidou, INSERM UMR970, PARCC, Centre de Référence des Maladies Vasculaires Rares, Hôpitaux Universitaires Paris Ouest, and Université Paris Descartes, Paris 5, Sorbonne Paris Cité; Paris France
| | - L. Biard
- AP-HP, SBIM, Hôpital Saint-Louis and Université Paris Diderot, Paris 7, INSERM, CRESS UMR-S 1153; Paris France
| | - J. Nizard
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière and Sorbonne Universités, Université Pierre et Marie Curie, Paris 6, CNRS UMR 7222, INSERM U1150; Paris France
| | - M. Lambert
- Hôpital Claude Huriez, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre Hospitalier Régional Universitaire de Lille, and Université de Lille 2; Lille France
| | - B. Wechsler
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Référence des Maladies Auto-Immunes et Systémiques Rares, and Université Pierre et Marie Curie, Paris 6; Paris France
| | - E. Hachulla
- Hôpital Claude Huriez, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre Hospitalier Régional Universitaire de Lille, and Université de Lille 2; Lille France
| | - L. Chiche
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris 6; Paris France
| | - F. Koskas
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris 6; Paris France
| | - J. Gaudric
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris 6; Paris France
| | - P. Cluzel
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris 6, INSERM-CNRS-LIB; Paris France
| | - E. Messas
- AP-HP, Hôpital Européen Georges-Pompidou, INSERM UMR970, PARCC, Centre de Référence des Maladies Vasculaires Rares, Hôpitaux Universitaires Paris Ouest, and Université Paris Descartes, Paris 5, Sorbonne Paris Cité; Paris France
| | - M. Resche-Rigon
- AP-HP, SBIM, Hôpital Saint-Louis and Université Paris Diderot, Paris 7, INSERM, CRESS UMR-S 1153; Paris France
| | - J. C. Piette
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Référence des Maladies Auto-Immunes et Systémiques Rares, and Université Pierre et Marie Curie, Paris 6; Paris France
| | - P. Cacoub
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Référence des Maladies Auto-Immunes et Systémiques Rares, and Université Pierre et Marie Curie, Paris 6; Paris France
| | - D. Saadoun
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Référence des Maladies Auto-Immunes et Systémiques Rares, and Université Pierre et Marie Curie, Paris 6; Paris France
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Rajagopalan S, Nwazota N, Chandrasekhar S. Outcomes in pregnant women with acute aortic dissections: a review of the literature from 2003 to 2013. Int J Obstet Anesth 2014; 23:348-56. [PMID: 25223644 DOI: 10.1016/j.ijoa.2014.05.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/07/2014] [Accepted: 05/05/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute aortic dissection in pregnant women is a rare but potentially life-threatening event. Our aim was to evaluate maternal and fetal outcomes of acute aortic dissection during pregnancy. METHODS We conducted a review of literature of the PubMed database to identify publications related to pregnant women with acute aortic dissections during the period 2003-2013: 59 articles were included in the study. RESULTS A total of 75 patients were included in the analyses. Stanford type A dissections were the most common form, accounting for 77% of all cases. The majority (78%) occurred in the third trimester and immediate postpartum period. Inherited connective tissue disorders were causative in 49% of patients. Maternal mortality was not statistical different between type A and type B dissections (21% vs. 23%), but fetal outcomes were worse in type B dissections (35% vs. 10.3%; P<0.05). Fetal mortality in type A dissections was dependent on the timing of aortic repair, with antepartum aortic repair associated with a higher mortality (36%). CONCLUSION Despite advances in diagnostic and surgical techniques, maternal and fetal mortalities in pregnant patients with aortic dissection remain high. Patients undergoing combined cesarean section with aortic repair had favorable fetal outcomes.
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Affiliation(s)
- S Rajagopalan
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA.
| | - N Nwazota
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - S Chandrasekhar
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
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Shu C, Fang K, Dardik A, Li X, Li M. Pregnancy-Associated Type B Aortic Dissection Treated With Thoracic Endovascular Aneurysm Repair. Ann Thorac Surg 2014; 97:582-7. [DOI: 10.1016/j.athoracsur.2013.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/22/2013] [Accepted: 09/04/2013] [Indexed: 12/11/2022]
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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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Gatto M, Iaccarino L, Canova M, Zen M, Nalotto L, Ramonda R, Punzi L, Doria A. Pregnancy and vasculitis: A systematic review of the literature. Autoimmun Rev 2012; 11:A447-59. [DOI: 10.1016/j.autrev.2011.11.019] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Upadhye S, Schiff K. Acute Aortic Dissection in the Emergency Department: Diagnostic Challenges and Evidence-Based Management. Emerg Med Clin North Am 2012; 30:307-27, viii. [DOI: 10.1016/j.emc.2011.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Clinical manifestations of pregnancy in patients with Takayasu arteritis: experience from a single tertiary center. Arch Gynecol Obstet 2011; 285:377-85. [DOI: 10.1007/s00404-011-1992-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 07/07/2011] [Indexed: 11/30/2022]
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