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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Aorta pathology and pregnancy.

Iris M van Hagen1, Jolien W Roos-Hesselink2

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Summary

Women with aortic diseases require pre-pregnancy counseling and risk assessment due to increased risks during pregnancy. Careful monitoring and potential interventions are crucial for maternal and fetal health, especially with aortic dilation.

Keywords:
Ehlers–Danlos syndromeLoeys–Dietz syndromeMarfan syndromeSmad3 proteinTurner syndromeaortic aneurysmdissectionpregnancy

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Area of Science:

  • Cardiovascular Medicine
  • Obstetrics and Gynecology
  • Genetics

Background:

  • Pregnancy induces significant hemodynamic and hormonal changes affecting the aortic wall.
  • Women with connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome) or pre-existing aortic abnormalities face elevated pregnancy-related risks.
  • Aortic dissection is a critical concern during pregnancy for affected individuals.

Purpose of the Study:

  • To emphasize the mandatory nature of pre-pregnancy counseling and risk assessment for women with known aortic disease.
  • To highlight the importance of comprehensive information regarding maternal and fetal risks, including disease recurrence.
  • To outline strategies for managing aortic disease during pregnancy to minimize complications.

Main Methods:

  • Review of existing literature and clinical guidelines on pregnancy management in women with aortic disease.
  • Emphasis on thorough pre-conception evaluation, including medical and family history.
  • Monitoring of aortic size and growth before and during pregnancy to assess dissection risk.

Main Results:

  • Pre-pregnancy counseling is essential for risk stratification and informed decision-making.
  • Prophylactic aortic repair before pregnancy may be indicated for dilated aortas.
  • Elective surgery during pregnancy or cesarean delivery might be necessary in specific cases, particularly with severe ascending aorta dilation.

Conclusions:

  • Comprehensive pre-pregnancy assessment and ongoing monitoring are vital for managing women with aortic disease.
  • Timely intervention, including prophylactic repair or modified delivery methods, can significantly improve outcomes.
  • Informed counseling empowers patients to understand and navigate the risks associated with pregnancy and aortic conditions.