P264. Pregnancy-associated Thoracic Aortic Aneurysm Growth Patterns and Complications
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Yale New Haven Hospital
New Haven, CT
United States - Contact Me
Dr. Nasir is a Postdoctoral Research Associate at the department of Cardiothoracic Surgery at Yale New Haven Hospital. Having seen disparities in healthcare provision to women across borders, Dr. Nasir hopes to combine the power of datasets and innovative technology to understand and outline the aortic healthcare experience of women scientifically.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Conflicting evidence exists regarding the impact of pregnancy on aortic aneurysm behavior. Here, we aim to assess the pattern of thoracic aortic size changes across pregnancy, to characterize incidence and timing of pregnancy-associated arterial complications and to analyze trends of management of high-risk pregnancies due to the presence of thoracic aortic aneurysm.
Methods: Electronic health record charts of thoracic aortic aneurysm patients with pregnancy and/or delivery at a single healthcare delivery network were reviewed.
Information was collected regarding demographics, aortic size from before, during and after pregnancy period where available, possible arterial complications, and clinical management of pregnancy.
Results: Twenty-seven patients with a total of 98 pregnancies (median per patient=3, IQR 2,4) were identified. Data were available for 42 pregnancies between 2011 and 2023.
At the time of the first index pregnancy, 7/27 mothers had no known diagnosis of thoracic aortic aneurysm despite 2 of the 7 patients known to have connective tissue disease. Rapid aortic size increase was observed in women with heritable thoracic aortic disease (HTAD) (N=14/22*) with an average growth rate of 0.1mm/ month (Fig. 01). No type A aortic dissection was noted in relation to pregnancy. Pregnancy-associated arterial complications (N=3, SCAD of LAD, IMH of descending aorta, rupture of the celiac artery) as well as maternal mortality (N=1) was observed in the peripartum period, solely in women with HTAD. Of the 20 patients that carried the diagnosis of thoracic aortic aneurysm prior to or during a total of 32 pregnancies, 25% (N=5/20) had received preconception counselling, 45% (N=9/20) received advice for strict blood pressure control, 80% (N=16/20) had aortic size monitoring during pregnancy via echocardiography and MRA imaging, and only 10% (N=2/20) required a CT surgeon on standby during delivery.
Conclusions: Pregnancy appears to impact growth rate of aortic aneurysm, particularly in heritable thoracic aortic disease. No acute aortic events were observed during pregnancy, however risk of pregnancy-related arterial complications is higher during peripartum period vs non-pregnancy period. Aortic surveillance during pregnancy is variable.
Authors
Afsheen Nasir (1), Christina Waldron (2), Prashanth Vallabhajosyula (1), Roland Assi (3)
Institutions
(1) Yale New Haven Hospital, New Haven, CT, (2) Yale School of Medicine, New Haven, CT, (3) Yale University School of Medicine, New Haven, CT
Methods: Electronic health record charts of thoracic aortic aneurysm patients with pregnancy and/or delivery at a single healthcare delivery network were reviewed.
Information was collected regarding demographics, aortic size from before, during and after pregnancy period where available, possible arterial complications, and clinical management of pregnancy.
Results: Twenty-seven patients with a total of 98 pregnancies (median per patient=3, IQR 2,4) were identified. Data were available for 42 pregnancies between 2011 and 2023.
At the time of the first index pregnancy, 7/27 mothers had no known diagnosis of thoracic aortic aneurysm despite 2 of the 7 patients known to have connective tissue disease. Rapid aortic size increase was observed in women with heritable thoracic aortic disease (HTAD) (N=14/22*) with an average growth rate of 0.1mm/ month (Fig. 01). No type A aortic dissection was noted in relation to pregnancy. Pregnancy-associated arterial complications (N=3, SCAD of LAD, IMH of descending aorta, rupture of the celiac artery) as well as maternal mortality (N=1) was observed in the peripartum period, solely in women with HTAD. Of the 20 patients that carried the diagnosis of thoracic aortic aneurysm prior to or during a total of 32 pregnancies, 25% (N=5/20) had received preconception counselling, 45% (N=9/20) received advice for strict blood pressure control, 80% (N=16/20) had aortic size monitoring during pregnancy via echocardiography and MRA imaging, and only 10% (N=2/20) required a CT surgeon on standby during delivery.
Conclusions: Pregnancy appears to impact growth rate of aortic aneurysm, particularly in heritable thoracic aortic disease. No acute aortic events were observed during pregnancy, however risk of pregnancy-related arterial complications is higher during peripartum period vs non-pregnancy period. Aortic surveillance during pregnancy is variable.
Authors
Afsheen Nasir (1), Christina Waldron (2), Prashanth Vallabhajosyula (1), Roland Assi (3)
Institutions
(1) Yale New Haven Hospital, New Haven, CT, (2) Yale School of Medicine, New Haven, CT, (3) Yale University School of Medicine, New Haven, CT