Acute aortic dissection and pregnancy: Review and meta‐analysis of incidence, presentation, and pathologic substrates

Martino, Andrea De; Morganti, Riccardo; Falcetta, Giosuè; Scioti, Giovanni; Milano, Aldo Domenico; Pucci, Angela; Bortolotti, Uberto

doi:10.1111/jocs.14305

Cited by 36 publications

(21 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reassuringly, we found no association between having MFS and experiencing preterm births. This was unexpected since connective tissue disorders are usually associated with this condition (De Martino et al, 2019; Kernell et al, 2017). Since preterm birth was not even increased in undiagnosed women with MFS, any preconception advice against pregnancy in the most severe cases with MFS cannot have influenced the results.…”

Section: Discussionmentioning

confidence: 98%

Maternal health and pregnancy outcome in diagnosed and undiagnosed Marfan syndrome: A registry‐based study

Groth

Nielsen

Sheyanth

et al. 2021

American J of Med Genetics Pt A

View full text Add to dashboard Cite

In Marfan syndrome (MFS), pregnancy is considered as high risk due to the deficiency of fibrillin in the connective tissue and increased risk of aortic dissection. The objective was to demonstrate the consequences on maternal health, in women with diagnosed and undiagnosed MFS at the time of pregnancy and childbirth. By using national health care registries, we identified all pregnancy related outcomes, from women with MFS (n = 183) and an age‐matched background population (n = 18,300). We found 91 pregnancies during follow‐up. Significantly fewer women with MFS gave birth, compared to the background population. No women with known MFS had a pregnancy related aortic dissection but complications related to the cervix were increased (HR:19.8 [95% CI:2.2–177.5]). Fifty women with MFS were undiagnosed at the time of their first pregnancy and/or childbirth. Among these, there were more birth canal related complications HR:27.2 (95% CI: 2.3–315.0), preeclampsia (HR:2.25 [95% CI: 1.11–4.60]), fetal deaths (HR:12.3 [95% CI: 1.51–99.8]), and all delivery‐related dissections came from this subgroup. In conclusion, undiagnosed women with MFS experienced more pregnancy and childbirth related complications including fetal death, birth canal issues, preeclampsia, and aortic disease, which emphasizes the need for an early MFS diagnosis and special care during pregnancy and childbirth.

show abstract

Section: Discussionmentioning

confidence: 98%

Maternal health and pregnancy outcome in diagnosed and undiagnosed Marfan syndrome: A registry‐based study

Groth

Nielsen

Sheyanth

et al. 2021

American J of Med Genetics Pt A

View full text Add to dashboard Cite

show abstract

“…For this reason, it is difficult to find a safe threshold and it is necessary to have a closer follow-up in these patients at particular risk. 3,7 Pyeritz, and Smith and Gros reported a negligible risk of cardiovascular complications in patients with MS and ascending aorta size < 40 mm. In the literature, the risk of dissection and rupture in MS is 1% when the aortic diameter is <40 mm 9,10 European guidelines on the management of ascending aortic disease in patients with MS recommend avoiding pregnancy or replacing the ascending aorta before when the aortic diameter is >45 mm or >40 mm if associated with a risk factor.…”

Section: Discussionmentioning

confidence: 99%

Aortic Aneurysm and Dissection in Pregnancy: Report of a Rare Case in a Marfan with Bicuspid Aortic Valve

Masiello

Leone

Benvenga

et al. 2020

IJCDW

View full text Add to dashboard Cite

Background Type A aortic dissection is an emergency with high morbidity and mortality when surgery is not performed. Few cases are described in the literature about aortic dissection during pregnancy. A correlation between pregnancy and aortic dissection is mainly reported in patients with family history and connective tissue disorders, such as Marfan’s syndrome (MS), Loeys–Dietz’s syndrome, and Ehlers–Danlos’s syndromes, and patients with bicuspid aortic valve (BAV); exceptional cases are also described in patients without risk factors. Case presentation A 22-year-old young woman with MS, ascending aorta dilation, and BAV became pregnant. During labor, she experienced a short-term chest pain with spontaneous resolution. The electrocardiogram (ECG) and cardiac biomarkers were negative for acute coronary artery disease, but no transthoracic echocardiogram (TTE) was performed. A caesarean section was performed without complications. After 1 month, a routine TTE showed a chronic ascending aortic dissection involving the aortic arch and supra-aortic vessels. Due to a normally functioning aortic valve, the David operation was performed (sparing aortic valve) with the replacement of the aortic arch and supra-aortic vessels. Conclusions Aortic dissection is a rare cardiovascular complication that can occur during pregnancy and is associated with very high-risk mortality. We have reported a rare case of undiagnosed type A aortic dissection involving the aortic arch during unplanned pregnancy in patients with BAV and MS, subsequently treated with the David surgery and replacement of ascending aortic arch and supra-aortic vessels. A closer clinical and instrumental follow-up is necessary in this particular group of patients at risk. Awareness of all physicians involved is mandatory.

show abstract

“…And the main feature of aortic dissection is the separation of the aortic media induced by blood flow [14]. And the development of aortic dissection may induce the occurrence of the aortic aneurysm [15]. However, the specific molecular mechanism of aortic dissection is still unclear.…”

Section: Discussionmentioning

confidence: 99%

miR-140-5p inhibits the proliferation, migration and invasion of vascular smooth muscle cells by suppressing the expression of NCKAP1

Liu

et al. 2021

Folia Histochem Cytobiol.

View full text Add to dashboard Cite

Introduction. The occurrence of aortic dissection is related to the proliferation and metastasis of vascular smooth muscle cells. In our present study, we found that the expression of miR-140-5p was inhibited in the wall of abdominal aorta of aortic dissection patients. However, the mechanism of miR-140-5p in the development of aortic dissection is unclear. Material and methods. We detected the expression of miR-140-5p and NCK Associated Protein 1 (NCKAP1) in blood vessel of aortic dissection patients and normal people by PCR. Next, we established the miR-140-5p overexpression and miR-140-5p inhibition vascular smooth muscle cells (CRL-1999 cells). The BrdU assays, wound healing assays and transwell assays were performed to detect the proliferation and invasion ability of these cells. Finally, luciferase reporter assay was performed to detect the relationship between miR-140-5p and NCKAP1. Results. The expression of miR-140-5p was suppressed in blood vessel of aortic dissection patients, and the levels of NCKAP1 in those tissues were upregulated. Overexpression of miR-140-5p inhibited the proliferation, migration and invasion of vascular smooth muscle cells. miR-140-5p targeted and suppressed the expression of NCKAP1. Conclusions. miR-140-5p repressed the proliferation, migration and invasion of vascular smooth muscle cells by targeting and inhibiting the expression of NCKAP1. Furthermore, the results of our study suggest new strategies and targets for the clinical treatment of arterial dissection.

show abstract

Acute aortic dissection and pregnancy: Review and meta‐analysis of incidence, presentation, and pathologic substrates

Cited by 36 publications

References 46 publications

Maternal health and pregnancy outcome in diagnosed and undiagnosed Marfan syndrome: A registry‐based study

Maternal health and pregnancy outcome in diagnosed and undiagnosed Marfan syndrome: A registry‐based study

Aortic Aneurysm and Dissection in Pregnancy: Report of a Rare Case in a Marfan with Bicuspid Aortic Valve

miR-140-5p inhibits the proliferation, migration and invasion of vascular smooth muscle cells by suppressing the expression of NCKAP1

Contact Info

Product

Resources

About