Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US.
Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, US.
Methodist Debakey Cardiovasc J. 2024 Mar 14;20(2):51-58. doi: 10.14797/mdcvj.1371. eCollection 2024.
Thoracic aortic disease (TAD) poses substantial risks during pregnancy, particularly for women with genetic conditions such as Marfan syndrome, Loeys-Dietz syndrome, and vascular Ehlers-Danlos syndrome. This review examines the epidemiology, risk assessment, and management of TAD in pregnancy. Preconception counseling is vital considering the hereditary nature of TAD and potential pregnancy-related complications. Genetic testing and imaging surveillance aid in risk assessment. Medical management, including beta-blockade and strict blood pressure control, is essential throughout pregnancy. Surgical interventions may be necessary in certain cases. A multidisciplinary approach involving cardiologists, obstetricians, cardiac surgeons, anesthesiologists, and other specialists with expertise in cardio-obstetrics is essential for optimal outcomes. Patient education and shared decision-making play vital roles in navigating the complexities of TAD in pregnancy and improving maternal and neonatal outcomes.
胸主动脉疾病(TAD)在妊娠期间带来了重大风险,特别是对于患有马凡综合征、Loeys-Dietz 综合征和血管型 Ehlers-Danlos 综合征等遗传疾病的女性。本文回顾了妊娠期间 TAD 的流行病学、风险评估和管理。鉴于 TAD 的遗传性和潜在的妊娠相关并发症,孕前咨询至关重要。遗传测试和影像学监测有助于进行风险评估。在整个妊娠期间,包括β受体阻滞剂和严格的血压控制在内的药物治疗是必要的。在某些情况下可能需要手术干预。涉及心脏病专家、产科医生、心脏外科医生、麻醉师和其他具有心脏产科专业知识的专家的多学科方法对于获得最佳结果至关重要。患者教育和共同决策在应对妊娠期间 TAD 的复杂性以及改善母婴结局方面发挥着至关重要的作用。