Personalized External Aortic Root Support Before Pregnancy in Heritable Thoracic Aortic Disease.

BACKGROUND

Heritable thoracic aortic disease (HTAD) increases the risk of aortic dissection, particularly during pregnancy and the puerperium. Standard management includes beta-blockers and, in selected cases, prophylactic aortic root surgery. Personalized external aortic root support (PEARS) offers an extravascular approach to aortic root support, but pregnancy data are scarce. This case series describes pregnancies in women with HTAD after PEARS.

CASE SUMMARY: Three pregnancies in 2 women with Marfan syndrome and familial thoracic aortic aneurysm and dissection who underwent preconception PEARS are presented. No dissections occurred. Aortic dimensions remained stable throughout pregnancy and follow-up (5 and 34 months). Pregnancies were uncomplicated, and all births were vaginal. Postpartum hemorrhage due to retained placenta occurred in all cases and was managed medically and by manual removal at the operating theater. Neonatal outcomes were favorable.

CONCLUSION

In this case series, PEARS seems to be a promising preconception strategy, with favorable cardiovascular, obstetric, and neonatal outcomes.