A 24-year-old woman with Marfan syndrome is seen preconceptually. Echocardiography shows aortic root diameter of 4.3 cm with mild aortic regurgitation and normal ventricular function. What is the most appropriate counselling?
- A Pregnancy is safe with beta blocker cover and six-monthly echocardiography
- B Risk depends only on family history of dissection, so echocardiographic size is irrelevant
- C Pregnancy carries substantial risk of aortic dissection; aortic root replacement should be considered before conception ✓
- D Caesarean section eliminates the cardiovascular risk of pregnancy
Correct answer: C. Pregnancy carries substantial risk of aortic dissection; aortic root replacement should be considered before conception
Explanation
An aortic root of 4.0 cm or larger in Marfan syndrome marks a high risk group for dissection during pregnancy, driven by hormonal medial degeneration and the hyperdynamic circulation. Guidelines recommend counselling against pregnancy and considering prophylactic root replacement before conception. Mode of delivery does not remove the nine-month haemodynamic burden, and size, not family history alone, drives individual risk stratification.
Reference: Fernando Arias' Practical Guide to High-Risk Pregnancy and Delivery, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.