Aortic Disease and Pregnancy : AHA statement
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Aortopathy in the pregnant woman carries substantial cardiovascular risk (modified WHO pregnancy risk category of III–IV) because of the combination of hemodynamic changes and hormonally driven structural effects on the integrity of vascular/ connective tissue. Heritable fibrillinopathies, bicuspid valve–associated aortopathy, and Turner syndrome are a few of the many causes of aortopathy, which results in aneurysms and dissection in women of childbearing age.

The heritability and syndromic features of genetic aortopathies are heterogeneous, as is the risk of pregnancy-associated maternal cardiovascular morbidity and mortality. Unfortunately, this contributes to the challenging nature of caring for these women in pregnancy. Several published guidelines address prophylactic aortic root replacement to avoid spontaneous dissection.However, data in pregnancy are less clear and may include consideration of absolute diameter and the ratio of a cross-section to height.

In general, a multipronged approach to women with aortopathy is required during the antepartum, peripartum, and postpartum periods with clinical evaluation of blood pressure and echocardiographic assessment of aortic dimensions. Consideration of pharmacological therapy with β-blockers for strict blood pressure control is recommended. Echocardiographic evaluation of the aorta should be performed during pregnancy may be reasonable every 12 weeks in low-risk women with the mildly dilated aorta and warranted every month in women with severely dilated aorta or at high risk of dissection) and at 6 months after delivery.

The cardio-obstetrics team approach would also include consideration of intervention if appropriate, multidisciplinary delivery planning, and postpartum follow-up, including when surgical replacement of the aorta is recommended. During pregnancy, Stanford type A dissection is a surgical emergency that would necessitate cardiothoracic surgical intervention to rapidly deliver the fetus and repair the dissection. Conservative medical management, including strict blood pressure control, is recommended for stable type B aortic dissections.

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