Peripartum type B aortic dissection in patients with Marfan syndrome who underwent aortic root replacement: a case series study

ObjectiveTo investigate pregnancy outcomes, especially the risk of pregnancy-related aortic dissection (AD), in patients with Marfan syndrome (MFS) after prophylactic aortic root replacement (ARR). DesignRetrospective case series study. SettingTertiary perinatal care centre at a university hospital. PopulationPregnant women fulfilling the revised Ghent nosology (2010) criteria for MFS who were managed at our institute. MethodsThe pregnancy outcomes of all patients with MFS managed at our institute between 1982 and September 2016 were reviewed retrospectively based on medical records. Main outcome measuresObstetrical management and complication including the incidence of AD throughout the peripartum period. ResultsAmong 22 patients (28 pregnancies) who had been managed as potential MFS or related disorders, 14 (17 pregnancies) fulfilled the revised Ghent nosology (2010) criteria for MFS and were enrolled in this study. Five patients (five pregnancies) had received ARR before conception: three (60%) developed type B aortic dissection [AD(B)] during the peripartum period, compared with only one of 10 patients (12 pregnancies) without ARR (P<0.05, Chi-square test). ConclusionsOur study results suggest that MFS patients after prophylactic ARR are still at high risk of AD(B) during the peripartum period. Careful pre-pregnancy counselling and multidisciplinary care throughout the peripartum period are essential for the management of MFS, even after surgical repair of an ascending aortic aneurysm. Tweetable abstractMFS patients after prophylactic ARR are still at high risk of type B aortic dissection during the peripartum period. Tweetable abstract MFS patients after prophylactic ARR are still at high risk of type B aortic dissection during the peripartum period.