A 26-year-old woman with Marfan syndrome is seen at 9 weeks gestation. Echocardiography shows an aortic root diameter of 4.6 cm with mild aortic regurgitation. What is the most appropriate counselling?
- A Pregnancy may continue with aspirin and review at term
- B Pregnancy is high risk because of aortic root dilatation above 4.5 cm and continuation should be reconsidered ✓
- C Beta blocker therapy makes the aortic risk negligible
- D Risk depends mainly on the degree of aortic regurgitation
Correct answer: B. Pregnancy is high risk because of aortic root dilatation above 4.5 cm and continuation should be reconsidered
Explanation
In Marfan syndrome, an aortic root diameter above 4.5 cm places the patient in the highest cardiovascular risk category, with substantial danger of aortic dissection during pregnancy and delivery driven by the hyperdynamic circulation and labour pains. Guidelines counsel against continuing such pregnancies or recommend aortic surgery before conception. Beta blockers reduce the rate of dilatation but do not neutralise dissection risk at this size. Regurgitation severity is secondary; the root dimension decides risk.
Reference: ESC Guidelines on Cardiovascular Diseases During Pregnancy, 2018 ed.
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Written and medically reviewed by the StethoPrep medical team.