Introduction: The risk of maternal death from aortic-dissection(AoD) during pregnancy/post-partum in TS is increased, due to TS-associated risk factors (bicuspid-aortic-valve(BAV), aortic-coarctation, aortic-dilatation, hypertension) and the increased cardiovascular strain of pregnancy itself. TS-guidelines advice against pregnancy in the presence of severe aortic-dilatation or moderate dilatation with AoD-risk factors; and after aortic surgery a high risk remains. However, few studies focus on cardiovascular outcomes in pregnant TS.
Methods: Retrospective study on 42 life-birth pregnancies among 25 TS women. Echocardiography/CMR pre-pregnancy(<2y pre-partum) and post-pregnancy(<2y post-partum) were collected. Measurements of sinuses of Valsalva(SoV) and ascending aorta(AA) were reviewed and adjusted for body-surface-area(ASI). AA-ASI≥20 mm/m2 defined moderately dilated aorta, ≥25 mm/m2 severely dilatated. Change in diameter pre- and post-pregnancy were compared with the growth rate of 70 nulliparous-TS.
Results: Cardiac-status at preconception was evaluated in 11/25 women. 2/11 had AA-ASI≥20 mm/m2, respectively, with BAV and hypertension. 3/11 had BAV, with repaired aortic-coarctation in 2. 1/25 had a previous AA-replacement. 2/25 had twin pregnancies with oocyte-donation. Post-pregnancy SoV and AA were significantly increased compared with pre-pregnancy values. The annual aortic-diameter-growth pregnancy-related was higher vs. nulliparous women. Among the five women with pre-exisiting AoD-risk factors, aortic-growth was higher, although not significant. There were no peri/post-pregnancy AoD.
|Time between cardiac-scans 3.6 (1.64) y||Pre-pregnancy||Post-pregnancy||Pregnant||Nulliparous|
|SoV, mm||28.0 ± 2.6||29.5 ± 3.8||<0.000|
|AA, mm||25.9 ± 3.7||28.1 ± 5.5||<0.000|
|SoV growth-rate, mm/y||0.53 ± 0.68||0.13 ± 0.59||0.044|
|AA growth-rate, mm/y||0.61 ± 0.67||0.22 ± 0.83||0.142|
Conclusions: This is the first study evaluating pre-pregnancy and post-pregnancy cardiovascular status in TS and suggest that aortic diameters increase during pregnancy, especially in women with pre-pregnancy AoD-risk factors. These data support the current guidelines regarding careful cardiovascular evaluation prior to any pregnancy and close pre and post-pregnancy monitoring.