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Aortic dissection management during pregnancy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Hardik Patel, M.D.

Overview

There are several recommendations for women with Marfan’s syndrome contemplating pregnancy, as well as for pregnant women with a know dilatation of the aortic root, or a known aortic aneurysm.

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)[1]

Genetic Syndromes (DO NOT EDIT)[1]

Class IIa
“1. For women with Marfan syndrome contemplating pregnancy, it is reasonable to prophylactically replace the aortic root and ascending aorta if the diameter exceeds 4.0 cm.[2] (Level of Evidence: C)”

Counseling and Management of Chronic Aortic Diseases in Pregnancy (DO NOT EDIT)[1]

Class I
“1. Women with Marfan syndrome and aortic dilatation, as well as patients without Marfan syndrome who have known aortic disease, should be counseled about the risk of aortic dissection as well as the heritable nature of the disease prior to pregnancy.[2][3] (Level of Evidence: C)”
“2. For pregnant women with known thoracic aortic dilatation or a familial or genetic predisposition for aortic dissection, strict blood pressure control, specifically to prevent Stage II hypertension, is recommended. (Level of Evidence: C)”
“3. For all pregnant women with known aortic root or ascending aortic dilatation, monthly or bimonthly echocardiographic measurements of the ascending aortic dimensions are recommended to detect aortic expansion until birth. (Level of Evidence: C)”
“4. For imaging of pregnant women with aortic arch, descending, or abdominal aortic dilatation, magnetic resonance imaging (without gadolinium) is recommended over computed tomographic imaging to avoid exposing both the mother and fetus to ionizing radiation. Transesophageal echocardiogram is an option for imaging of the thoracic aorta. (Level of Evidence: C)”
“5. Pregnant women with aortic aneurysms should be delivered where cardiothoracic surgery is available. (Level of Evidence: C)”
Class IIa
“1. Fetal delivery via cesarean section is reasonable for patients with significant aortic enlargement, dissection, or severe aortic valve regurgitation.[3] (Level of Evidence: C)”
Class IIb
“1. If progressive aortic dilatation and/or advancing aortic valve regurgitation are documented, prophylactic surgery may be considered.[4] (Level of Evidence: C)”

References

  1. ↑ 1.0 1.1 1.2 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE; et al. (2010). “2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine”. Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780.
  2. ↑ 2.0 2.1 Pearson GD, Devereux R, Loeys B; et al. (2008). “Report of the National Heart, Lung, and Blood Institute and National Marfan Foundation Working Group on research in Marfan syndrome and related disorders”. Circulation. 118 (7): 785–91. doi:10.1161/CIRCULATIONAHA.108.783753. PMC 2909440. PMID 18695204. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Milewicz DM, Dietz HC, Miller DC (2005). “Treatment of aortic disease in patients with Marfan syndrome”. Circulation. 111 (11): e150–7. doi:10.1161/01.CIR.0000155243.70456.F4. PMID 15781745. Unknown parameter |month= ignored (help)
  4. ↑ Immer FF, Bansi AG, Immer-Bansi AS; et al. (2003). “Aortic dissection in pregnancy: analysis of risk factors and outcome”. Ann. Thorac. Surg. 76 (1): 309–14. PMID 12842575. Unknown parameter |month= ignored (help)

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