Cardiac disease in pregnancy and connective tissue disorders: Difference between revisions
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{{ | {{Cardiac disease in pregnancy}} | ||
{{CMG}}; | {{CMG}}; {{AOEIC}} {{AC}}, {{CZ}}, {{CA}} | ||
==Overview== | ==Overview== | ||
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Of note, there have been case reports of congenital heart block in infants born to parents with congenital heart disease.<ref name="pmid16218462">{{cite journal| author=Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, Piette JC| title=Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. | journal=Lupus | year= 2005 | volume= 14 | issue= 9 | pages= 660-4 | pmid=16218462 | doi= | pmc= | url= }} </ref> | Of note, there have been case reports of congenital heart block in infants born to parents with congenital heart disease.<ref name="pmid16218462">{{cite journal| author=Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, Piette JC| title=Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. | journal=Lupus | year= 2005 | volume= 14 | issue= 9 | pages= 660-4 | pmid=16218462 | doi= | pmc= | url= }} </ref> | ||
==[[Marfan's syndrome | ==Marfan's Syndrome== | ||
Marfan syndrome (or Marfan's syndrome) is a connective tissue disorder most often caused by defects in the [[Fibrillin-1 gene]] ([[FBN1]]). Patients with Marfan's syndrome are at significant risk of skeletal, cardiovascular and ocular complications. People with Marfan's are typically tall, with long [[Limb (anatomy)|limb]]s and long thin fingers. | |||
====Considerations for a pregnant patient with Marfan's Syndrome==== | |||
*The syndrome has autosomal dominant inheritance, therefore pre pregnancy counseling is important to advise prospective parents about the risks of transmission. | |||
*Most common in 3rd trimester or 1st stage of labor | |||
*Assessment for the mother should include clinical and [[Cardiac disease in pregnancy echocardiography|echocardiographic]] cardiovascular evaluation should be performed, as well as [[Cardiac disease in pregnancy MRI|magnetic resonance imaging]] or [[Cardiac disease in pregnancy CT|computed tomography]] assessment of the entire aorta.<ref name="pmid12842575">{{cite journal| author=Immer FF, Bansi AG, Immer-Bansi AS, McDougall J, Zehr KJ, Schaff HV et al.| title=Aortic dissection in pregnancy: analysis of risk factors and outcome. | journal=Ann Thorac Surg | year= 2003 | volume= 76 | issue= 1 | pages= 309-14 | pmid=12842575 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12842575 }} </ref><ref name="pmid7503207">{{cite journal| author=Rossiter JP, Repke JT, Morales AJ, Murphy EA, Pyeritz RE| title=A prospective longitudinal evaluation of pregnancy in the Marfan syndrome. | journal=Am J Obstet Gynecol | year= 1995 | volume= 173 | issue= 5 | pages= 1599-606 | pmid=7503207 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7503207 }} </ref> | |||
*'''''If ascending aorta is larger than 40mm, pregnancy is generally contraindicated.''''' One study has described that pregnancy is safe up to a diameter of 45mm.<ref name="pmid15681576">{{cite journal| author=Meijboom LJ, Vos FE, Timmermans J, Boers GH, Zwinderman AH, Mulder BJ| title=Pregnancy and aortic root growth in the Marfan syndrome: a prospective study. | journal=Eur Heart J | year= 2005 | volume= 26 | issue= 9 | pages= 914-20 | pmid=15681576 | doi=10.1093/eurheartj/ehi103 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15681576 }} </ref> | |||
*The mother should have periodic echocardiographic surveillance every 6 to 8 weeks to follow aortic root size. | *The mother should have periodic echocardiographic surveillance every 6 to 8 weeks to follow aortic root size. | ||
For a more detailed review of Marfan's syndrome, click [[Marfan's syndrome|here]]. | *There should be a low threshold throughout pregnancy for [[aortic dissection]]. | ||
*Prophylactic [[beta-blockers]] appear to be helpful. | |||
*During labor, pushing should be kept to a minimm, with an assisted second stage if necessary. | |||
*Surgery recommended pre-conception if root diameter >40 mm and during gestation if > 55 mm. | |||
==Related Chapter== | |||
'''''For a more detailed review of Marfan's syndrome, click [[Marfan's syndrome|here]].''''' | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Obstetrics]] | [[Category:Obstetrics]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 19:02, 18 April 2012
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Cardiac disease in pregnancy Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Anjan K. Chakrabarti, M.D. [2], Cafer Zorkun, M.D., Ph.D. [3], Assistant Editor-In-Chief: Cassandra Abueg, M.P.H. [4]
Overview
The most common connective tissue disorder that effects the cardiovascular system in pregnancy is Marfan's syndrome, which will be reviewed in this section.
Of note, there have been case reports of congenital heart block in infants born to parents with congenital heart disease.[1]
Marfan's Syndrome
Marfan syndrome (or Marfan's syndrome) is a connective tissue disorder most often caused by defects in the Fibrillin-1 gene (FBN1). Patients with Marfan's syndrome are at significant risk of skeletal, cardiovascular and ocular complications. People with Marfan's are typically tall, with long limbs and long thin fingers.
Considerations for a pregnant patient with Marfan's Syndrome
- The syndrome has autosomal dominant inheritance, therefore pre pregnancy counseling is important to advise prospective parents about the risks of transmission.
- Most common in 3rd trimester or 1st stage of labor
- Assessment for the mother should include clinical and echocardiographic cardiovascular evaluation should be performed, as well as magnetic resonance imaging or computed tomography assessment of the entire aorta.[2][3]
- If ascending aorta is larger than 40mm, pregnancy is generally contraindicated. One study has described that pregnancy is safe up to a diameter of 45mm.[4]
- The mother should have periodic echocardiographic surveillance every 6 to 8 weeks to follow aortic root size.
- There should be a low threshold throughout pregnancy for aortic dissection.
- Prophylactic beta-blockers appear to be helpful.
- During labor, pushing should be kept to a minimm, with an assisted second stage if necessary.
- Surgery recommended pre-conception if root diameter >40 mm and during gestation if > 55 mm.
Related Chapter
For a more detailed review of Marfan's syndrome, click here.
References
- ↑ Costedoat-Chalumeau N, Georgin-Lavialle S, Amoura Z, Piette JC (2005). "Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block". Lupus. 14 (9): 660–4. PMID 16218462.
- ↑ Immer FF, Bansi AG, Immer-Bansi AS, McDougall J, Zehr KJ, Schaff HV; et al. (2003). "Aortic dissection in pregnancy: analysis of risk factors and outcome". Ann Thorac Surg. 76 (1): 309–14. PMID 12842575.
- ↑ Rossiter JP, Repke JT, Morales AJ, Murphy EA, Pyeritz RE (1995). "A prospective longitudinal evaluation of pregnancy in the Marfan syndrome". Am J Obstet Gynecol. 173 (5): 1599–606. PMID 7503207.
- ↑ Meijboom LJ, Vos FE, Timmermans J, Boers GH, Zwinderman AH, Mulder BJ (2005). "Pregnancy and aortic root growth in the Marfan syndrome: a prospective study". Eur Heart J. 26 (9): 914–20. doi:10.1093/eurheartj/ehi103. PMID 15681576.