PMID- 26311451
OWN - NLM
STAT- MEDLINE
DCOM- 20150925
LR  - 20221207
IS  - 0529-567X (Print)
IS  - 0529-567X (Linking)
VI  - 50
IP  - 5
DP  - 2015 May
TI  - [Maternal and fetal outcomes with aortic dissection in pregnant patients with 
      Marfan syndrome].
PG  - 334-40
AB  - OBJECTIVE: To evaluate the clinical characteristics of aortic dissection in 
      pregnant patients with Marfan syndrome and the maternal and fetal outcomes in 
      cardiovascular surgery. METHODS: Seven pregnant women with Marfan syndrome with 
      aortic dissection were identified, who were treated in Beijing Anzhen Hospital 
      Affiliated to Capital Medical University between January 2012 and September 2014. 
      Patient charts were reviewed for cardiovascular surgery, occurrence of 
      complications, clinical features and the maternal and fetal outcomes. RESULTS: 
      (1) Among 7 patients, 4 cases were diagnosed as type A aortic dissection and 3 
      were cases diagnosed as type B aortic dissection. The diagnosis mainly depends on 
      CT angiography. New York Heart Association (NYHA) classify into 5 of level II, 1 
      of level III, 1 of leveI IV. Except for 1 patient with cardiac tamponade lead to 
      heart failure, the remaining 6 cases had no complications. (2) Three patients 
      underwent heart surgery with cardiopulmonary bypass in second trimester and two 
      patients underwent heart surgery in third trimester. Two patients terminated 
      pregnancy before heart surgery (one of whom underwent artificial abortion, one of 
      whom underwent cesarean section in second trimester). (3) The methods of 
      cardiovascular surgeries were as follow: 3 of Bentall+Sun', 1 of Bentall+Sun'+ 
      right coronary artery bypass grafting, 1 of Bentall, 1 of the whole chest aorta 
      replacement surgery, and 1 of femoral artery catheter chest aorta with membrane 
      mesh stent implantation. The diameter of aortic roots measured during operation 
      were 5 cm in 2 cases, 7 cm in 2 cases and 10 cm in 2 cases respectively. Among 
      the 7 cases, 3 were conducted cesarean sections during cardiovascular surgery, 1 
      was terminated pregnancy due to intrauterine fetal death after cardiovascular 
      surgery, and 1 was conducted cesarean section due to severe early-onset 
      preeclampsia at 30 weeks of pregnancy after cardiovascular surgery. (4) Among the 
      7 cases, 3 were conducted cesarean sections during cardiovascular surgery, the 
      order of which was implemented cesarean section under general anesthesia firstly 
      and then operated cardiovascular surgery with cardiopulmonary bypass and 
      heparinization. Two were conducted cardiovascular surgery after termination of 
      pregnancy by early artificial abortion operation or hysterotomy. 1 was conducted 
      Bentall surgery at 18 weeks of pregnancy, after that the patient was receiving 
      warfarin until the fetal brain hemorrhage was examined by ultrasound at 31 weeks 
      of pregnancy; the patient was conducted cesarean section due to intrauterine 
      fetal death. 1 was conducted heart surgery at 24 weeks of pregnancy and continue 
      the pregnancy to 30 weeks, was conducted cesarean section due to severe 
      early-onset preeclampsia at 30 weeks of pregnancy. (5) Among 7 patients, three 
      patients underwent heart surgery with cardiopulmonary bypass combined with 
      cesarean section. Two patients terminated pregnancy after heart surgery. Two 
      patients terminated pregnancy before heart surgery. Six patients were alive and 
      one patient died of multiple organ failure. (6) 3 cases of newborn with birth 
      body mass between 1 080 to 1 490 g.1 case of birth died after 14 d. 2 cases for 
      newborns were alive without exception. CONCLUSION: Aortic dissection poses 
      serious risk for pregnant women with Marfan syndrome and the fetus, and the 
      mortality rates for both the mother and the fetus are high. Early diagnosis and 
      appropriate treatment should be based on maternal and fetal conditions (such as 
      aortic dissection, gestational age). When fetus is mature, cardiovascular surgery 
      should be carried out with cesarean section. A multi-disciplinary team between 
      obstetric and cardiovascular surgery is crucial to the outcome of these critical 
      patients.
FAU - Yang, Puyu
AU  - Yang P
AD  - Department of Obstetrics and Gynecology, Beijing Anzhen Hospital Affiliated to 
      Capital Medical University, Beijing 100029, China.
FAU - Zhang, Jun
AU  - Zhang J
FAU - Li, Yanna
AU  - Li Y
FAU - Wang, Hui
AU  - Wang H
FAU - Zheng, Jun
AU  - Zheng J
AD  - Email: drzhangj@outlook.com.
LA  - chi
PT  - Case Reports
PT  - Journal Article
PL  - China
TA  - Zhonghua Fu Chan Ke Za Zhi
JT  - Zhonghua fu chan ke za zhi
JID - 16210370R
SB  - IM
MH  - Adult
MH  - Aortic Dissection/diagnosis
MH  - Aortic Aneurysm/complications/surgery
MH  - Cardiac Surgical Procedures/methods
MH  - Cesarean Section
MH  - Female
MH  - Fetal Death
MH  - Fetus
MH  - Gestational Age
MH  - Humans
MH  - Infant, Newborn
MH  - Marfan Syndrome/*complications
MH  - Pregnancy
MH  - *Pregnancy Complications, Cardiovascular
MH  - *Pregnancy Outcome
MH  - Pregnancy Trimester, Third
MH  - *Pregnancy, High-Risk
MH  - Retrospective Studies
MH  - Ultrasonography, Prenatal
EDAT- 2015/08/28 06:00
MHDA- 2015/09/26 06:00
CRDT- 2015/08/28 06:00
PHST- 2015/08/28 06:00 [entrez]
PHST- 2015/08/28 06:00 [pubmed]
PHST- 2015/09/26 06:00 [medline]
PST - ppublish
SO  - Zhonghua Fu Chan Ke Za Zhi. 2015 May;50(5):334-40.