Abstract 18452: Outcome of Pregnancy in Women with Aortic Disease: Data from ROPAC
Objectives: Cardiovascular disease is one of the major causes of maternal mortality. Pregnancy induces marked hemodynamic changes and may weaken the structure of the vessel wall. The aim of the present study is to describe the outcome of pregnancy in patients with aortic disease.
Methods and Results: In the Registry Of Pregnancy And Cardiac disease (ROPAC), 2966 patients were enrolled from 39 countries. One hundred and one patients had aortic disease: 56 patients with Marfan syndrome (55.4%), 12 associated with bicuspid aortic valve (11.9%), 2 with Turner Syndrome (2.0%), 2 with familial thoracic aortic aneurysm disease (2.0%) and 29 with other aortic diseases (28.7%) e.g. Takayasu arteritis or previous aortic dissection without specified diagnosis. During pregnancy, aortic dissection occurred in 3 patients: a type B dissection in a Marfan patient at 25 weeks with a prior aortic diameter of 42 mm; a type A dissection in a Marfan patient at 37 weeks (pre-pregnancy aortic diameter not reported) and at 26 weeks in one patient with a prior aneurysm (diameter 60mm). The first two patients used a beta-blocker during pregnancy. All patients underwent surgical replacement of the aorta directly after Caesarean Section (CS). The patient with type B dissection had her caesarean section at 33 weeks. No fetal loss occurred. A fourth patient, also affected with Marfan syndrome, suffered a type A aortic dissection at 7 days after delivery. Her pre-pregnancy aortic diameter was 26mm and she did not use a beta-blocker during pregnancy. There was no maternal mortality and only one miscarriage in all 101 cases. CS was performed in 64.6% of the patients compared with 47.1% (p=0.001) in the rest of the registry.
Conclusion: Pregnant patients with aortic disease are at risk of aortic dissection with an incidence in Marfan patients of 5.4%. This is mainly seen in the second half of pregnancy or shortly after delivery. In this registry, no maternal mortality or fetal loss were observed after aortic dissection.
Author Disclosures: I.M. van Hagen: None. M.R. Johnson: None. R. Hall: None. J.W. Roos-Hesselink: None.
- © 2014 by American Heart Association, Inc.