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Ceuppens AS, De Meester P, Van De Bruaene A, Voigt JU, Van Calsteren K, Budts W, Troost E. Aorta pathology and pregnancy-related risks in adult congenital cardiac disease: does the aorta dilate during pregnancy? Obstet Med 2024; 17:41-46. [PMID: 38660320 PMCID: PMC11037198 DOI: 10.1177/1753495x231156851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/20/2023] [Indexed: 04/26/2024] Open
Abstract
Background Aortic dilatation and pregnancy are major concerns in women with aortopathy (AOP). This single-centre retrospective analysis focuses on the evolution of aortic diameters during and after pregnancy in women with Marfan syndrome (MS), Turner syndrome (TS) and bicuspid aortic valve (BAV) aortopathy. Methods and results Thirty-eight women who had one or more single pregnancies were included. The ascending aorta was measured during pregnancy and postpartum. During pregnancy, a significant increase of diameters of the sinus aortae (median 1.4 mm; [-1.3; 3.8]) and ascending aorta (median 2.1 mm; [0.0; 4.0]) was noted. Systemic hypertension gives dilation of the aorta, but it did not influence the overall trajectory during pregnancy. Conclusion Significant aortic dilatation is noted during pregnancy in women with underlying AOP, even persisting in the long term. Pre-existing systemic hypertension is associated with larger aortic diameters prior to pregnancy. More research on a larger study population however is needed.
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Affiliation(s)
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | | | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Els Troost
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
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2
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DeCarlo C, Boitano LT, Molina RL, Weinberg I, Conrad MF, Eagleton MJ, Dua A. Pregnancy and Preeclampsia Are Associated With Acute Adverse Peripheral Arterial Events. Arterioscler Thromb Vasc Biol 2020; 41:526-533. [PMID: 33054392 DOI: 10.1161/atvbaha.120.315174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Acute peripheral arterial events, such as aortic dissection, carotid artery dissection, vertebral artery dissection, and ruptured renoviseral aneurysms, have been reported during pregnancy in case series, but there is a paucity of population-based data. This study sought to establish pregnancy and preeclampsia as risk factors for acute peripheral arterial events. Approach and Results: All women who gave birth between 1998 and 2020 within a multicenter health care system were identified. Births that occurred in women <18 or >50 years of age were excluded. Primary outcome was any acute peripheral arterial event that was symptomatic or required intervention. Cox regression model was used to evaluate the association between vascular events and pregnancy as a time-varying covariate. The pregnancy exposure period was from the estimated date of conception to 3 months postpartum. There were 277 697 pregnancies (81.3% deliveries, 17.0% abortions, and 1.7% ectopics) among 176 635 women with 1.68 million patient-years of total follow-up (median, 7.9 years; interquartile range, 2.4-16.2). Preeclampsia complicated 5.3% of pregnancies; 67 790 of 225 763 (30.0%) deliveries were delivered by cesarean. Ninety-six acute arterial events occurred during follow-up, of which 24 occurred during pregnancy, including the postpartum period. Pregnancy (hazard ratio, 1.85 [95% CI, 1.01-3.38]; P=0.046) and preeclampsia (hazard ratio, 10.9 [95% CI, 5.24-22.7]; P<0.001) were significant independent predictors of acute arterial events. CONCLUSIONS While taking into account limitations from estimating conception and outcome dates, pregnancy, especially when complicated by preeclampsia, is associated with an increased risk of acute peripheral arterial events.
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Affiliation(s)
- Charles DeCarlo
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Laura T Boitano
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Rose L Molina
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (R.L.M.).,Division of Women's Health, Brigham and Women's Hospital, Boston, MA (R.L.M.)
| | - Ido Weinberg
- Fireman Vascular Center (I.W.), Massachusetts General Hospital, Boston.,Department of Medicine, Division of Vascular Medicine (I.W.), Massachusetts General Hospital, Boston
| | - Mark F Conrad
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Matthew J Eagleton
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Anahita Dua
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
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Habashi JP, MacFarlane EG, Bagirzadeh R, Bowen C, Huso N, Chen Y, Bedja D, Creamer TJ, Rykiel G, Manning M, Huso D, Dietz HC. Oxytocin antagonism prevents pregnancy-associated aortic dissection in a mouse model of Marfan syndrome. Sci Transl Med 2020; 11:11/490/eaat4822. [PMID: 31043570 DOI: 10.1126/scitranslmed.aat4822] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 09/14/2018] [Accepted: 03/25/2019] [Indexed: 01/18/2023]
Abstract
Women with Marfan syndrome (MFS) are at high risk for pregnancy-associated aortic dissection. Pathogenic models that singularly invoke hemodynamic stress are difficult to reconcile with predominant postnatal occurrence of aortic tear, often occurring weeks to months after delivery. In consideration of events that peak at term, are sustained after delivery, and might synergize with previously defined signaling pathways implicated in aneurysm progression, we examined the hormone oxytocin, which initiates uterine contraction and milk letdown for the duration of lactation through phosphorylation of extracellular signal-regulated kinase (ERK). In a mouse model of MFS that shows highly penetrant postnatal aortic dissection, risk was strongly attenuated by preventing lactation or use of an oxytocin receptor antagonist. Survival correlated inversely with the extent of ERK activation in the aortic wall, and strong protection was observed upon attenuation of ERK phosphorylation using an inhibitor of ERK kinase (MEK) or the U.S. Food and Drug Administration-approved medication hydralazine, offering potential therapeutic strategies for pregnancy-associated vascular catastrophe in the setting of MFS.
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Affiliation(s)
| | | | - Rustam Bagirzadeh
- Center for Medical Genetics, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Caitlin Bowen
- Center for Medical Genetics, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Nicholas Huso
- Center for Medical Genetics, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Yichun Chen
- Center for Medical Genetics, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Djahida Bedja
- Division of Comparative Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Tyler J Creamer
- Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Graham Rykiel
- Center for Medical Genetics, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Maurice Manning
- Department of Cancer Biology, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - David Huso
- Division of Comparative Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Harry C Dietz
- Center for Medical Genetics, Johns Hopkins University, Baltimore, MD 21287, USA. .,Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
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4
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Birth characteristics of women with Marfan syndrome, obstetric and neonatal outcomes of their pregnancies—A nationwide cohort and case-control study. Eur J Obstet Gynecol Reprod Biol 2017; 215:106-111. [DOI: 10.1016/j.ejogrb.2017.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 11/22/2022]
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Epidural Anesthesia for Cesarean Section in a Pregnant Woman with Marfan Syndrome and Dural Ectasia. Case Rep Obstet Gynecol 2017; 2017:2126310. [PMID: 28611929 PMCID: PMC5458362 DOI: 10.1155/2017/2126310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/19/2017] [Indexed: 11/29/2022] Open
Abstract
Marfan syndrome (MFS) is a genetic disorder of connective tissue, characterized by variable clinical features and multisystem complications. The anesthetic management during delivery is debated. Regional anesthesia has been used with success during cesarean delivery, but in some MFS patients there is a probability of erratic and inadequate spread of intrathecal local anesthetics as a result of dural ectasia. In these cases, epidural anesthesia may be a particularly useful technique during cesarean delivery because it allows an adequate spread and action of local anesthetic with a controlled onset of anesthesia, analgesia, and sympathetic block and a low risk of perioperative complications. We report the perioperative management of a patient with MFS and dural ectasia who successfully underwent cesarean section using epidural technique anesthesia. The previous pregnancy of this woman ended with cesarean section with a failed spinal anesthesia that was converted to general anesthesia due to unknown dural ectasia at that time.
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De Backer J, Muiño-Mosquera L, Demulier L. Aortopathy. PREGNANCY AND CONGENITAL HEART DISEASE 2017. [DOI: 10.1007/978-3-319-38913-4_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Muiño Mosquera L, De Backer J. Managing aortic aneurysms and dissections during pregnancy. Expert Rev Cardiovasc Ther 2015; 13:703-14. [DOI: 10.1586/14779072.2015.1042862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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8
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Abstract
Up to half of all aortic dissections and ruptures in women younger than 40 years are associated with pregnancy. In pregnancy, women with aortic disease such as arteritis and aortitis are at significant risk of aneurysmal formation and dissection with potential for catastrophic outcomes. Pregnancy places predisposed women at an increased risk of dissection due to physiological and hormonal changes that occur, particularly those with connective tissue disorders, genetic syndromes, congenital heart disease, and other heritable and acquired conditions involving the aorta. Thus, preconception counseling and preparation are advised to determine which patients may cautiously pursue pregnancy, to optimize medical management prior to conception (antihypertensive medications and anticoagulants in the setting of mechanical valves), to identify women in whom aortic root repair should occur prior to pregnancy, and lastly, those in whom pregnancy is contraindicated. Additionally, discussion of the heritable nature of many aortic conditions and associated syndromes is indicated. Preconception and genetic counseling, management by a multidisciplinary team, along with close echocardiographic surveillance and medical management, are recommended if precursors of dissection are identified.
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Affiliation(s)
- Dorothy A Smok
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th St, PH-16, New York, NY 10032.
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9
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Curry RA, Gelson E, Swan L, Dob D, Babu-Narayan SV, Gatzoulis MA, Steer PJ, Johnson MR. Marfan syndrome and pregnancy: maternal and neonatal outcomes. BJOG 2014; 121:610-7. [PMID: 24418012 PMCID: PMC4162995 DOI: 10.1111/1471-0528.12515] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 11/30/2022]
Abstract
Objective To report outcomes in a recent series of pregnancies in women with Marfan syndrome (MFS). Design Retrospective case note review. Setting Tertiary referral unit (Chelsea and Westminster and Royal Brompton Hospitals). Sample Twenty-nine pregnancies in 21 women with MFS between 1995 and 2010. Methods Multidisciplinary review of case records. Main outcome measures Maternal and neonatal mortality and morbidity of patients with MFS and healthy controls. Results There were no maternal deaths. Significant cardiac complications occurred in five pregnancies (17%): one woman experienced a type–A aortic dissection; two women required cardiac surgery within 6 months of delivery; and a further two women developed impaired left ventricular function during the pregnancy. Women with MFS were also more likely to have obstetric complications (OR 3.29, 95% CI 1.30–8.34), the most frequent of which was postpartum haemorrhage (OR 8.46, 95% CI 2.52–28.38). There were no perinatal deaths, although babies born to mothers with MFS were delivered significantly earlier than those born to the control group (median 39 versus 40 weeks of gestation, Mann–Whitney U–test, P = 0.04). These babies were also significantly more likely to be small for gestational age (24% in the MFS group versus 6% in the controls; OR 4.95, 95% CI 1.58–15.55). Conclusions Pregnancy in women with MFS continues to be associated with significant rates of maternal, fetal, and neonatal complications. Effective pre-pregnancy counselling and meticulous surveillance during pregnancy, delivery, and the puerperium by an experienced multidisciplinary team are warranted for women with MFS.
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Affiliation(s)
- R A Curry
- Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, UK; Academic Department of Obstetrics and Gynaecology, Faculty of Medicine, Imperial College London, Chelsea and Westminster NHS Foundation Trust, London, UK
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Allyn J, Guglielminotti J, Omnes S, Guezouli L, Egan M, Jondeau G, Longrois D, Montravers P. Marfan’s Syndrome During Pregnancy. Anesth Analg 2013; 116:392-8. [DOI: 10.1213/ane.0b013e3182768f78] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Schoormans D, Radonic T, de Witte P, Groenink M, Azim D, Lutter R, Mulder BJM, Sprangers MAG, Zwinderman AH. Mental quality of life is related to a cytokine genetic pathway. PLoS One 2012; 7:e45126. [PMID: 23049769 PMCID: PMC3458023 DOI: 10.1371/journal.pone.0045126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 08/14/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Quality of life (QoL) in patients with chronic disease is impaired and cannot be solely explained by disease severity. We explored whether genetic variability and activity contributes to QoL in patients with Marfan syndrome (MFS), a genetic connective tissue disorder. METHODOLOGY/PRINCIPAL FINDINGS In 121 MFS patients, patient characteristics (i.e. demographics and MFS-related symptoms) were assessed. Patients completed the SF-36 to measure QoL. In addition, transcriptome wide gene expression and 484 Single Nucleotide Polymorphysms (SNPs) in cytokine genes were available. QoL was first analyzed and associated with patient characteristics. Patients' physical QoL was impaired and weakly related with age and scoliosis, whereas mental quality of life (MCS) was normal. To explain a largely lacking correlation between disease severity and QoL, we related genome wide gene expression to QoL. Patients with lower MCS scores had high expression levels of CXCL9 and CXCL11 cytokine-related genes (p=0.001; p=0.002); similarly, patients with low vitality scores had high expression levels of CXCL9, CXCL11 and IFNA6 cytokine-related genes (p=0.02; p=0.02; p=0.04), independent of patient characteristics. Subsequently, we associated cytokine related SNPs to mental QoL (MCS and vitality). SNP-cluster in the IL4R gene showed a weak association with MCS and vitality (strongest association p=0.0017). Although overall mental QoL was normal, >10% of patients had low scores for MCS and vitality. Post-hoc analysis of systemic inflammatory mediators showed that patients with lowest MCS and vitality scores had high levels of CCL11 cytokine (p=0.03; p=0.04). CONCLUSIONS/SIGNIFICANCE Variation in the cytokine genetic pathway and its activation is related to mental QoL. These findings might allow us to identify and, ultimately, treat patients susceptible to poor QoL.
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Affiliation(s)
- Dounya Schoormans
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Teodora Radonic
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Piet de Witte
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Maarten Groenink
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Donija Azim
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Rene Lutter
- Departments of Pulmonology and Experimental Immunology Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara J. M. Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | | | - Aeilko H. Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
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12
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Michaelson-Cohen R, Elstein D, Ioscovich A, Armon S, Schimmel MS, Butnaru A, Samueloff A, Grisaru-Granovsky S. Severe heart disease complicating pregnancy does not preclude a favourable pregnancy outcome: 15 years' experience in a single centre. J OBSTET GYNAECOL 2012; 31:597-602. [PMID: 21973131 DOI: 10.3109/01443615.2011.603064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Heart disease (HD) in pregnancy remains a major cause of non-obstetric maternal and neonatal mortality and morbidity. This study describes the outcome in 164 pregnant women with HD (158 deliveries in women in New York Heart Association (NYHA) Classes 1 and 2; 17 in NYHA Classes 3 and 4) who received good antenatal care and benefitted from a specific protocol and experience of a dedicated staff. There were no maternal or neonatal deaths; 46 women were diagnosed peripartum. Based on a sub-division into NYHA categories, and when sub-divided by HD, there were no statistically significant differences between groups with regard to maternal age, gestational age at admission or at delivery, birth weight, 5 min Apgar scores, mode of delivery (caesarean delivery), senior obstetric/anaesthesiology staff in attendance or delivery during day/working hours. There was a higher incidence of pre-term deliveries in women with rheumatic heart disease and Marfan syndrome (p = 0.06) relative to others. Babies of women with coronary heart disease had prolonged postpartum course in the NICU (p = 0.0001) and longer total hospital stays for the mother. In conclusion, well-managed, motivated mothers with HD who benefit from comprehensive antenatal care, and are managed primarily by their obstetric and anaesthesia teams, can aspire to a good outcome for themselves and their babies.
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Affiliation(s)
- R Michaelson-Cohen
- Department Obstetrics and Gynecology, Hebrew University of Jerusalem, Shaare Zedek Medical Centre, Jerusalem, Israel
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14
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Abstract
Marfan syndrome is a connective-tissue disease inherited in an autosomal dominant manner and caused mainly by mutations in the gene FBN1. This gene encodes fibrillin-1, a glycoprotein that is the main constituent of the microfibrils of the extracellular matrix. Most mutations are unique and affect a single amino acid of the protein. Reduced or abnormal fibrillin-1 leads to tissue weakness, increased transforming growth factor beta signaling, loss of cell-matrix interactions, and, finally, to the different phenotypic manifestations of Marfan syndrome. Since the description of FBN1 as the gene affected in patients with this disorder, great advances have been made in the understanding of its pathogenesis. The development of several mouse models has also been crucial to our increased understanding of this disease, which is likely to change the treatment and the prognosis of patients in the coming years. Among the many different clinical manifestations of Marfan syndrome, cardiovascular involvement deserves special consideration, owing to its impact on prognosis. However, the diagnosis of patients with Marfan syndrome should be made according to Ghent criteria and requires a comprehensive clinical assessment of multiple organ systems. Genetic testing can be useful in the diagnosis of selected cases.
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Affiliation(s)
- Sorel Goland
- From the Department of Medicine and Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles (U.E.), and Kaplan Medical Center, Rehovot, Israel (S.G.)
| | - Uri Elkayam
- From the Department of Medicine and Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles (U.E.), and Kaplan Medical Center, Rehovot, Israel (S.G.)
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Singh SI, Brooks C, Dobkowski W. General anesthesia using remifentanil for Cesarean delivery in a parturient with Marfan’s syndrome. Can J Anaesth 2008; 55:526-31. [DOI: 10.1007/bf03016673] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Affiliation(s)
- Martin G. Keane
- From the Departments of Medicine (M.G.K., R.E.P.) and Genetics (R.E.P.) and the Institute for Cardiovascular Medicine (M.G.K., R.E.P.), University of Pennsylvania School of Medicine, Philadelphia
| | - Reed E. Pyeritz
- From the Departments of Medicine (M.G.K., R.E.P.) and Genetics (R.E.P.) and the Institute for Cardiovascular Medicine (M.G.K., R.E.P.), University of Pennsylvania School of Medicine, Philadelphia
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Massive retrograde acute type B aortic dissection in a postpartum woman with a family history of Marfan syndrome. J Clin Anesth 2008; 20:50-3. [DOI: 10.1016/j.jclinane.2007.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 06/11/2007] [Accepted: 06/11/2007] [Indexed: 11/19/2022]
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Davies GAL, Herbert WNP. HEART DISEASE IN PREGNANCY 2: Congenital Heart Disease in Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007; 29:409-414. [PMID: 17493372 DOI: 10.1016/s1701-2163(16)35492-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congenital heart disease has become more prevalent in women of childbearing age and represents about 75% of the heart disease seen in pregnancy. Close monitoring by both obstetricians and cardiologists is advisable for women with complex heart disease, and pregnancy should still be considered contraindicated in several types of congenital heart disease. Women should also be advised of the risk that their offspring may be affected. Women at increased risk for a cardiac event in pregnancy include those with a prior cardiac event or arrhythmia, NYHA functional class > II or cyanosis, left heart obstruction, and systemic ventricular dysfunction. In the absence of adverse predictors, however, women with congenital heart disease can be assured that pregnancy does not pose a significant risk to their health.
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Affiliation(s)
- Gregory A L Davies
- Professor and Chair, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Queen's University, Kingston ON
| | - William N P Herbert
- William Norman Thornton Professor and Chair, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville VA
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20
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Abstract
The Marfan's syndrome is an autosomal dominant genetic disorder resulting in a diminished strength of connective tissue. The ocular, skeletal and cardiovascular systems are mostly at risk. Principal complications of the disease are aortic dilatation and the risk of acute dissection. Pregnancy increases this risk. Based on the experience of our obstetrics department and after reviewing medical literature, we have tried to establish guidelines for obstetric care adapted to pregnant patients affected by Marfan's syndrome. Women with aortic root > 40 mm should avoid pregnancy. In all cases B-adrenergic receptor blockers must be used as soon as possible. Because there is a 50% risk that offspring will inherit the syndrome, prenatal diagnosis should be suggested. In addition to usual pregnancy monitoring, echocardiography should be performed every 3 months as well as 2 months after delivery. No increase of obstetrical complications has been shown in these patients. Route of delivery also depends on the diameter of the aortic root: vaginal delivery is warranted if the aortic root is<40; cesarean section should be performed in the other cases. Thus, with appropriate supervision, women with Marfan's syndrome will tolerate pregnancy without any adverse effect.
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Affiliation(s)
- A Lunel
- Service de Gynécologie Obstétrique, Pavillon K, Hôpital Edouard-Herriot, place d'Arsonval, 69437 Lyon Cedex 03
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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
Congenital heart disease is now more prevalent than acquired in pregnancy in the developed world. In pregnancy the fall in systemic vascular resistance and increase in blood volume and cardiac output can cause functional deterioration in certain conditions. A minimally symptomatic woman with good ventricular function, normal oxygen saturation, and no left heart obstruction should tolerate pregnancy well. Women with pulmonary hypertension or dilated aortic root (pre-replacement) should be counselled against pregnancy and given appropriate contraceptive advice. The optimum management of a pregnant woman with a metallic prosthetic valve remains to be determined.
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Affiliation(s)
- C E G Head
- Department of Cardiology, University Hospital, Birmingham, UK.
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