Management of aortic valve involvement with Marfan syndrome during pregnancy
Dr. Sonal Tanwar, Dr. Naresh Sen, Dr. Ashok Jain
Patients with MFS should be followed during pregnancy jointly by their obstetrician and cardiologist. For patients with normal-size aorta, antenatal visits should be scheduled every month, and an echocardiogram should be scheduled during each trimester and before the delivery. In patients with aortic diameter ≥40 mm, progressive dilation, or a history of aortic surgery for aortic dilatation or dissection, an echocardiographic examination should be performed every 4 to 6 weeks. Vaginal delivery is safe in patients with MFS who have no significant cardiovascular involvement and normal aortic diameter (<40 mm). Patients with aortic dilatation ≥40 mm, progressive dilatation of the aorta during pregnancy, or a history of aortic repair for prior dissection are at high risk for aortic dissection and should therefore have an elective cesarean section with epidural or general anesthesia to minimize hemodynamic changes associated with vaginal delivery. In case of an urgent need for surgery and to prevent unfavorable fetal outcome, an immediate cesarean section followed by cardiac surgery is recommended.
Dr. Sonal Tanwar, Dr. Naresh Sen, Dr. Ashok Jain. Management of aortic valve involvement with Marfan syndrome during pregnancy. International Journal of Medicine Research, Volume 2, Issue 5, 2017, Pages 24-29