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Neo-Aortic Root Dilation in Pregnancy After Arterial Switch for Complete Transposition of the Great Arteries
Ariane Hébert Métellus1, François-Pierre Mongeon2, Doan Hoa Do3
1Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.
Background:
The arterial switch operation (ASO) is standard treatment for D-transposition of the great arteries, and neo-aortic dilation is common afterward. Its behavior during pregnancy remains uncertain, especially the risk of dissection.
Case:
We describe a 30-year-old woman (G6P0A5) with neo-aortic dilation (44 mm) during her first pregnancy, which remained stable on beta blockers until an uncomplicated caesarean delivery. In her subsequent pregnancy, an initial measurement of 47 mm raised concern. Expert review highlighted the challenges of accurately measuring asymmetric neo-aortas post-ASO and confirmed that the neo-aorta was stable (43 mm). The pregnancy continued without complications under beta-blocker therapy.
Discussion:
No neo-aortic dissections have been reported after ASO, and progression above 2 mm was reported only in a few (2/131). Preconception evaluation, standardized measurement techniques, and trimester-based surveillance are essential. Mode of delivery should be individualized; caesarean delivery may be reasonable when dilation exceeds 45 mm.
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