Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-25T10:34:10.814Z Has data issue: false hasContentIssue false

3 - Vascular diseases

from Section 1 - Cardiovascular and respiratory disorders

Published online by Cambridge University Press:  19 October 2009

By
David R. Gambling
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
David R. Gambling
Affiliation:
Clinical Associate Professor, (non-salaried) Department, Anesthesiology, University of California San Diego, CA USA; Staff Anesthesiologist, Sharp Mary Birch Hospital for Women
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
Get access

Summary

Introduction

Maternal vascular lesions that become apparent during pregnancy may be present before conception but only become symptomatic as a result of the physiologic changes of pregnancy. Blood vessels are weakened by an increase in blood volume and cardiac output (CO); a decrease in systemic vascular resistance (SVR); and hormonal changes. Hence, aneurysms can expand and rupture, or arteriovenous (AV) malformations can grow and, if present in the pulmonary circulation, can worsen a preexisting shunt. Some of the rare conditions described in this chapter affect blood vessels in discrete areas of the body whereas others affect all blood vessels. Often the disorders described are part of an autoimmune disease process that impacts other organ systems. Many of the vascular disorders are associated with high maternal and neonatal mortality. For example, rupture of an enlarging aneurysm can cause abrupt, catastrophic blood loss and poor peripartum outcomes. Likewise, pulmonary hypertension worsens during pregnancy and is often associated with maternal and/or neonatal death. This chapter discusses the clinical implications for the obstetric anesthesiologist of most vascular lesions seen during pregnancy. Intracranial aneurysms during pregnancy are discussed in Chapter 9.

Primary pulmonary hypertension

Primary pulmonary hypertension is a progressive disease that produces a sustained rise of at least 25 mmHg in mean pulmonary artery pressure and an increase in pulmonary resistance, in the absence of an identified pulmonary or cardiac lesion. This inevitably leads to right ventricular (RV) dilatation and RV hypertrophy progressing to RV failure and death.

Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 57 - 74
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Roberts, N. V. & Keast, P. J.Pulmonary hypertension and pregnancy: a lethal combination. Anaesth. Intensive Care 1990; 18: 366–74.Google Scholar
Cohen, R., Talwar, A. & Efferen, L. S.Exacerbation of underlying pulmonary disease in pregnancy. Crit. Care Clin. 2004; 20: 713–30.Google Scholar
Rich, S.Primary pulmonary hypertension. Prog. Cardiovasc. Dis. 1988; 31: 205–38.Google Scholar
Mangano, D. T. Anesthesia for the pregnant cardiac patient. In Hughes, S. C., Levinson, G. & Rosen, M. A. (eds), Shnider and Levinson's Anesthesia for Obstetrics, 4th edn. Philadelphia: Lippincott Williams and Wilkins, 2001; pp. 471–2.
Harnett, M., Mushlin, P. S. & Camann, W. R. Cardiovascular disease. In Chestnut, D. H. (ed.), Obstetric Anesthesia: Principles and Practice, 3rd edn. Philadelphia: Elsevier Mosby, 2004; pp. 710–11.
Fuster, V., Steele, P. M., Edwards, W. D.et al. Primary pulmonary hypertension: natural history and the importance of thrombosis. Circulation 1984; 70: 580–7.Google Scholar
Takeuchi, T., Nishii, O., Okamura, T. & Yaginuma, T.Primary pulmonary hypertension in pregnancy. Int. J. Gynecol. Obstet. 1988; 26: 145–50.Google Scholar
Nelson, D. M., Main, E., Crafford, W. & Ahumada, G. G.Peripartum heart failure due to primary pulmonary hypertension. Obstet. Gynecol. 1983; 62: S58–63.Google Scholar
Dawkins, K. D., Burke, C. M., Billingham, M. E.et al. Primary pulmonary hypertension and pregnancy. Chest 1986; 89: 383–8.Google Scholar
Feijen, H. W. H., Hein, P. R., Lakwijk-Vondrovicova, E. L. & Nijhuis, G. M.Primary pulmonary hypertension and pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol. 1983; 15: 159–64.Google Scholar
Weiss, B. M., Zemp, L., Seifert, B. & Hess, O. M.Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J. Am. Coll. Cardiol. 1998; 31: 1650–7.Google Scholar
Naeije, R. & Vachiery, J. L.Medical therapy of pulmonary hypertension. Conventional therapies. Clin. Chest Med. 2001; 22: 517–27.Google Scholar
Rubin, L. J., Badesch, D. B., Barst, R. J.et al. Bosentan therapy for pulmonary arterial hypertension. N. Engl. J. Med. 2002; 346: 896–903.Google Scholar
O'Hare, R., McLoughlin, C., Milligan, K., McNamee, D. & Sidhu, H.Anaesthesia for caesarean section in the presence of severe primary pulmonary hypertension. Br. J. Anaesth. 1998; 8: 790–2.Google Scholar
Lam, G. K., Stafford, R. E., Thorp, J., Moise, K. J. Jr & Cairns, B. A.Inhaled nitric oxide for primary pulmonary hypertension in pregnancy. Obstet. Gynecol. 2001; 98: 895–8.Google Scholar
Bildirici, I. & Shumway, J. B.Intravenous and inhaled epoprostenol for primary pulmonary hypertension during pregnancy and delivery. Obstet. Gynecol. 2004; 103: 1102–5.Google Scholar
Stewart, R., Tuazon, D., Olson, G. & Duarte, A. G.Pregnancy and primary pulmonary hypertension: successful outcome with epoprostenol therapy. Chest 2001; 119: 973–5.Google Scholar
Hill, L. L., Wet, C. J., Jacobsohn, E., Leighton, B. L. & Tymkew, H.Peripartum substitution of inhaled for intravenous prostacyclin in a patient with primary pulmonary hypertension. Anesthesiology 2004; 100: 1603–5.Google Scholar
Breen, T. W. & Janzen, J. A.Pulmonary hypertension and cardiomyopathy: anaesthetic management for Caesarean section. Can. J. Anaesth. 1991; 38: 895–9.Google Scholar
Sullivan, J. M. & Ramanathan, K. B.Management of medical problems in pregnancy: severe cardiac disease. N. Engl. J. Med. 1985; 313: 304–9.Google Scholar
Braun, E. B., Palin, C. A. & Hogue, C. W.Vasopressin during spinal anesthesia in a patient with primary pulmonary hypertension treated with intravenous epoprostenol. Anesth. Analg. 2004; 99: 36–7.Google Scholar
Slomka, F., Salmeron, S., Zetlaoui, P.et al. Primary pulmonary hypertension and pregnancy: anesthetic management for delivery. Anesthesiology 1988; 69: 959–61.Google Scholar
Nootens, M. & Rich, S.Successful management of labor and delivery in primary pulmonary hypertension. Am. J. Cardiol. 1993; 71: 1124–5.Google Scholar
Robinson, D. E. & Leicht, C. H.Epidural analgesia with low-dose bupivacaine and fentanyl for labor and delivery in a parturient with severe pulmonary hypertension. Anesthesiology 1988; 68: 285–8.Google Scholar
Smedstad, K. G., Cramb, R. & Morison, D. H.Pulmonary hypertension and pregnancy: a series of eight cases. Can. J. Anaesth. 1994; 41: 502–12.Google Scholar
Power, K. J. & Avery, A. F.Extradural analgesia in the intrapartum management of a patient with pulmonary hypertension. Br. J. Anaesth. 1989; 63: 116–20.Google Scholar
Khan, M. J., Bhatt, S. B. & Kryc, J. J.Anesthetic considerations for parturients with primary pulmonary hypertension: review of the literature and clinical presentation. Int. J. Obstet. Anesth. 1996; 5: 36–42.Google Scholar
Roessler, P. & Lambert, T. F.Anaesthesia for caesarean section in the presence of primary pulmonary hypertension. Anaesth. Intensive Care 1986; 14: 317–20.Google Scholar
Ackerman, W. E. & Juneja, M. M.Should epidural fentanyl be given for labor and delivery in a patient with severe pulmonary hypertension?Anesthesiology 1988; 69: 284–5.Google Scholar
Abboud, T. K., Raya, J., Noueihed, R. & Daniel, J.Intrathecal morphine for relief of labor pain in a parturient with severe pulmonary hypertension. Anesthesiology 1983; 59: 477–9.Google Scholar
Leduc, L., Kirshon, B., Diaz, S. F. & Cotton, D. B.Intrathecal morphine analgesia and low-dose dopamine for oliguria in severe maternal pulmonary hypertension: a case report. J. Reprod. Med. 1990; 35: 727–9.Google Scholar
Weeks, S. K. & Smith, J. B.Obstetric anesthesia in patients with primary pulmonary hypertension. (Editorial) Can. J. Anaesth. 1991; 38: 814–16.Google Scholar
Atanassoff, P., Alon, E., Schmid, E. R. & Pasch, T.Epidural anesthesia for Caesarean section in a patient with severe pulmonary hypertension. Acta Anaesth. Scand. 1990; 34: 75–7.Google Scholar
Duggan, A. B. & Katz, S. G.Combined spinal and epidural anaesthesia for caesarean section in a parturient with severe primary pulmonary hypertension. Anaesth. Intensive Care 2003; 31: 565–9.Google Scholar
Batson, M. A., Longmire, S. & Csontos, E.Alfentanil for urgent Caesarean section in a patient with severe mitral stenosis and pulmonary hypertension. Can. J. Anaesth. 1990; 37: 685–8.Google Scholar
Myles, P. S.Anaesthetic management for laparoscopic sterilisation and termination of pregnancy in a patient with severe primary pulmonary hypertension. Anaesth. Intensive Care 1994; 22: 465–9.Google Scholar
Olofsson, C., Bremme, K., Forssell, G. & Ohqvist, G.Cesarean section under epidural ropivacaine 0.75% in a parturient with severe pulmonary hypertension. Acta Anaesthesiol. Scand. 2001; 45: 258–60.Google Scholar
Decoene, C., Bourzoufi, K., Moreau, D.et al. Use of inhaled nitric oxide for emergency Cesarean section in a woman with unexpected primary pulmonary hypertension. Can. J. Anaesth. 2001; 48: 584–7.Google Scholar
Weiss, B. M., Maggiorini, M., Jenni, R.et al. Pregnant patient with primary pulmonary hypertension: inhaled pulmonary vasodilators and epidural anesthesia for cesarean delivery. Anesthesiology 2000; 92: 1191–4.Google Scholar
Sorensen, C. H., Sorensen, M. B. & Jacobsen, E.Pulmonary hemodynamics during direct diagnostic laryngoscopy. Acta Anaesth. Scand. 1981; 25: 51–7.Google Scholar
Satoh, H., Masuda, Y., Izuta, S., Yaku, H. & Obara, H.Pregnant patient with primary pulmonary hypertension; general anesthesia and extracorporeal membrane oxygenation support for termination of pregnancy. Anesthesiology 2002; 97: 1638–40.Google Scholar
Monnery, L., Nanson, J. & Charlton, G.Primary pulmonary hypertension in pregnancy; a role for novel vasodilators. Br. J. Anaesth. 2001; 87: 295–8.Google Scholar
Bonnin, M., Mercier, F. J., Sitbon, O.et al. Severe pulmonary hypertension during pregnancy: mode of delivery and anesthetic management of 15 consecutive cases. Anesthesiology 2005; 102: 1133–7.Google Scholar
Hodgson, C. H., Burchell, H. B., Good, C. A. & Clagett, O. T.Hereditary hemorrhagic telangiectasia and pulmonary arteriovenous fistula: survey of a large family. N. Engl. J. Med. 1959; 261: 625–36.Google Scholar
Hodgson, C. H. & Kaye, R. L.Pulmonary arteriovenous fistula and hereditary hemorrhagic telangiectasia: a review and report of 35 cases of fistula. Dis. Chest 1963; 43: 449–55.Google Scholar
Chanatry, B. J.Acute hemothorax owing to pulmonary arteriovenous malformation in pregnancy. Anesth. Analg. 1992; 74: 613–15.Google Scholar
LaRoche, C. M., Wells, F. & Shneerson, J.Massive hemothorax due to enlarging arteriovenous fistula in pregnancy. Chest 1992; 101: 1452–4.Google Scholar
Bevelaqua, F. A., Ordorica, S. A., Lefleur, R. & Young, B.Osler-Weber-Rendu disease: diagnosis and management of spontaneous hemothorax during pregnancy. N. Y. State J. Med. 1992; 92: 551–2.Google Scholar
Peery, W. H.Clinical spectrum of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu Disease): a review. Am. J. Med. 1987; 82: 989–97.Google Scholar
Baumgardner, D. J. & Kroll, M. R.Pulmonary arteriovenous malformations in pregnancy. Am. Fam. Phys. 1993; 48: 1032–3.Google Scholar
Begbie, M. E., Wallace, G. M. & Shovlin, C. L.Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): a view from the 21st century. Postgrad. Med. J. 2003; 79: 18–24.Google Scholar
Swinburne, A. J.Pregnancy and pulmonary arterio-venous fistula (editorial). N.Y. State J. Med. 1992; 92: 515–16.Google Scholar
Gammon, R. B., Miksa, A. K. & Keller, F. S.Osler-Weber-Rendu disease and pulmonary arteriovenous fistulas: deterioration and embolotherapy during pregnancy. Chest 1990; 98: 1522–4.Google Scholar
Ference, B. A., Shannon, T. M., White, R. I. Jr, Zawin, M. & Burdge, C. M.Life-threatening pulmonary arteriovenous malformations and hereditary hemorrhagic telangiectasia. Chest 1994; 106: 1387–90.Google Scholar
McCausland, A. M., Hyman, C., Winsor, T. & Trotter, A. D. Jr.Venous distensibility during pregnancy. Am. J. Obstet. Gynecol. 1961; 81: 472–9.Google Scholar
McCausland, A. M., Holmes, F. & Trotter, A. D.Venous distensibility during the menstrual cycle. Am. J. Obstet. Gynecol. 1963; 86: 640–5.Google Scholar
Pritchard, J. A.Changes in the blood volume during pregnancy and delivery. Anesthesiology 1965; 26: 393–9.Google Scholar
Jahnke, V.Ultrastructure of hereditary telangiectasia. Arch. Otolaryngol. 1970; 91: 262–5.Google Scholar
Waring, P. H., Shaw, B. & Brumfield, C. G.Anesthetic management of a patient with Osler-Weber-Rendu syndrome and rheumatic heart disease. Anesth. Analg. 1990; 71: 96–9.Google Scholar
Burke, C. M., Safai, C., Nelson, D. P. & Raffin, T. A.Pulmonary arteriovenous malformations: a critical update. Am. Rev. Respir. Dis. 1986; 134: 334–9.Google Scholar
Gershon, A. S., Faughnan, M. E., Chon, K. S.et al. Transcatheter embolotherapy of maternal pulmonary arteriovenous malformations during pregnancy. Chest 2001; 119: 470–7.Google Scholar
Chao, H. S., Chern, M. S., Chen, Y. C. & Chang, S. C.Recurrence of pulmonary arteriovenous malformations in a female with hereditary hemorrhagic telangiectasia. Am. J. Med. Sci. 2004; 327: 294–8.Google Scholar
Freixinet, J., Sanchex-Palacios, M., Guerrero, D.et al. Pulmonary arteriovenous fistula ruptured to pleural cavity in pregnancy. Scand. J. Thorac. Cardiovasc. Surg. 1995; 29: 39–41.Google Scholar
Esplin, M. S. & Varner, M. W.Progression of pulmonary arteriovenous malformation during pregnancy: case report and review of the literature. Obstet. Gynecol. Surv. 1997; 52: 248–53.Google Scholar
Jakobi, P., Weiner, Z., Best, L. & Itskovitz-Eldor, J.Hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformations. Obstet. Gynecol. 2001; 97: 813–14.Google Scholar
Wilmshurst, P. & Jackson, P.Arterial hypoxemia during pregnancy caused by pulmonary arteriovenous microfistulas. Chest 1996; 110: 1368–9.Google Scholar
Sharma, D., Pandia, M. P. & Bithal, P. K.Anaesthetic management of Osler-Weber-Rendu syndrome with coexisting congenital methaemoglobinaemia. Acta Anaesthesiol. Scand. 2005; 49: 1391–4.Google Scholar
Thevenot, T., Vanlemmens, C., Di Martino, V.et al. Liver transplantation for cardiac failure in patients with hereditary hemorrhagic telangiectasia. Liver Transpl. 2005; 11:834–8.Google Scholar
Finkelstein, R., Engel, A., Simri, W. & Hemli, J. A.Brain abscesses: the lung connection. J. Intern. Med. 1996; 240: 33–6.Google Scholar
Swanson, K. L., Prakash, U. B. & Stanson, A. W.Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982–1997. Mayo Clin. Proc. 1999; 74: 671–80.Google Scholar
Marks, F., Santos, A., Leppert, P.et al. Peripheral pulmonary artery stenosis in pregnancy. A report of two cases. J. Reprod. Med. 1992; 37: 381–2.Google Scholar
Landsberger, E. J. & Grossman, J. H.Multiple peripheral pulmonic stenosis in pregnancy. Am. J. Obstet. Gynecol. 1986; 154: 152–3.Google Scholar
Togo, T., Sugishita, Y., Tamura, T.et al. Uneventful pregnancy and delivery in a case of multiple peripheral pulmonary stenoses. Acta Cardiol. 1983; 38: 143–51.Google Scholar
Hankins, G. D., Brekken, A. L. & Davis, L. M.Maternal death secondary to a dissecting aneurysm of the pulmonary artery. Obstet. Gynecol. 1985; 65: S45–8.Google Scholar
D'Arbela, P. G., Mugerwa, J. W., Patel, A. K. & Somers, K.Aneurysm of pulmonary artery with persistent ductus arteriosus and pulmonary infundibular stenosis: fatal dissection and rupture in pregnancy. Br. Heart J. 1970; 32: 124–6.Google Scholar
Haridas, K. K., Neeraakal, G. M., Moorthy, S., Prabhu, N. K. & Kumar, V.Ruptured idiopathic pulmonary artery aneurysm: unusual case of hemothorax treated by selective embolization. Indian Heart J. 2001; 53: 769–72.Google Scholar
Gruber, P. J., Askin, F. B. & Heitmiller, R. F.Pulmonary artery aneurysm in a pregnant woman. Ann. Thorac. Surg. 2001; 71: 1023–5.Google Scholar
Green, N. J. & Rollason, T. P.Pulmonary artery rupture in pregnancy complicating patent ductus arteriosus. Br. Heart J. 1992; 68: 616–18.Google Scholar
Ramanthan, S., Gupta, U., Chalon, J. & Turndorf, H.Anesthetic considerations in Takayasu's arteritis. Anesth. Analg. 1979; 58: 247–9.Google Scholar
Lupi, E., Sanchez, G., Horwitz, S. & Gutierrez, E.Pulmonary artery involvement in Takayasu's arteritis. Chest 1975; 67: 69–74.Google Scholar
Nasu, T.Pathology of pulseless disease: systematic study and critical review of twenty-one autopsy cases reported in Japan. Angiology 1963; 14: 225–42.Google Scholar
Crofts, S. L. & Wilson, E.Epidural analgesia for labour in Takayasu's arteritis: case report. Br. J. Obstet. Gynecol. 1991; 98: 408–9.Google Scholar
McKay, R. S. & Dillard, S. R.Management of epidural anesthesia in a patient with Takayasu's disease. Anesth. Analg. 1992; 74: 297–9.Google Scholar
Nakao, K., Ikeda, M., Kimata, S., Niitani, H. & Niyahara, M.Takayasu's arteritis: clinical report of eighty-four cases and immunological studies of seven cases. Circulation 1967; 35: 1141–55.Google Scholar
Ueno, A., Awane, Y., Wakabayashi, A. & Shimizu, K.Successfully operated obliterative brachiocephalic arteritis (Takayasu) associated with the elongated coarctation. Jpn. Heart J. 1967; 8: 538–44.Google Scholar
Ishikawa, K.Natural history and classification of occlusive thromboaortopathy (Takayasu's Disease). Circulation 1978; 57: 27–35.Google Scholar
Sabbadini, M. G., Bozzolo, E., Baldissera, E. & Bellone, M.Takayasu's arteritis: therapeutic strategies. J. Nephrol. 2001; 14: 525–31.Google Scholar
Kerr, G. S., Hallahan, C. W., Giordano, J.et al. Takayasu arteritis. Ann. Intern. Med. 1994; 120: 919–29.Google Scholar
Hauth, J. C., Cunningham, F. G. & Young, B. K.Takayasu's syndrome in pregnancy. Obstet. Gynecol. 1977; 50: 373–5.Google Scholar
Bassa, A., Desai, D. K. & Moodley, J.Takayasu's disease and pregnancy. Three case studies and a review of the literature. S. Afr. Med. J. 1995; 85: 107–12.Google Scholar
Mahmood, T., Dewart, P. J., Ralston, A. J. & Elstein, M.Three successive pregnancies in a patient with Takayasu's arteritis. J. Obstet. Gynaecol. 1997; 17: 52–4.Google Scholar
Sharma, K., Jain, S. & Vasishta, K.Outcome of pregnancy in Takayasu arteritis. Int. J. Cardiol. 2000; 75: S159–62.Google Scholar
Ishikawa, K. & Matsuura, S.Occlusive thromboaortopathy (Takayasu's disease) and pregnancy: clinical course and management of 33 pregnancies and deliveries. Am. J. Cardiol. 1982; 50: 1293–300.Google Scholar
Thorburn, J. R. & James, M. F. M.Anaesthetic management of Takayasu's arteritis. Anaesthesia 1986; 41: 734–8.Google Scholar
Rocha, M. P., Guntupalli, K. K., Moise, K. J. Jret al. Massive hemoptysis in Takayasu's arteritis during pregnancy. Chest 1994; 106: 1619–22.Google Scholar
Winn, H. N., Setaro, J. F., Mazor, M.et al. Severe Takayasu's arteritis in pregnancy: the role of central hemodynamic monitoring. Am. J. Obstet. Gynecol. 1988; 159: 1135–6.Google Scholar
Tomioka, N., Hirose, K., Abe, E.et al. Indications for peripartum aortic pressure monitoring in Takayasu's disease. A patient with a past history of intrapartum cerebral hemorrhage. Jpn. Heart. J. 1998; 39: 255–60.Google Scholar
Matsumura, A., Moriwaki, R. & Numano, F.Pregnancy in Takayasu's arteritis from the view of internal medicine. Heart Vessels 1992; 7: S120–4.Google Scholar
Hampl, K. F., Schneider, M. C., Skarvan, K., Bitzer, J. & Graber, J.Spinal anaesthesia in a patient with Takayasu's disease. Br. J. Anaesth. 1994; 72: 129–32.Google Scholar
Gaida, B. J., Gervais, H. W., Mauer, D., Leyser, K. H. & Eberle, B.Anesthesiology problems in Takayasu's Syndrome. Anaesthesist 1991; 40: 1–6.Google Scholar
Beilin, Y. & Bernstein, H.Successful epidural anaesthesia for a patient with Takayasu's arteritis presenting for Caesarean section. Can. J. Anaesth. 1993; 40: 64–6.Google Scholar
Warner, M. A., Hughes, D. R. & Messick, J. M.Anesthetic management of a patient with Pulseless Disease. Anesth. Analg. 1983; 62: 532–5.Google Scholar
Wiebers, D. O.Ischemic cerebrovascular complications of pregnancy. Arch. Neurol. 1985; 42: 1106–13.Google Scholar
Henderson, K. & Fludder, P.Epidural anaesthesia for caesarean section in a patient with severe Takayasu's disease. Br. J. Anaesth. 1999; 83: 956–9.Google Scholar
Liou, J. T., Sun, M. S., Lin, Y. H.et al. Combined spinal-epidural anesthesia for cesarean section in a patient with Takayasu's disease. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63: 66–70.Google Scholar
Clark, A. G. & al-Qatari, M.Anaesthesia for Caesarean section in Takayasu's disease. Can. J. Anaesth. 1998; 45: 377–9.Google Scholar
Herrema, I.Takayasu's disease and Caesarean section. Int. J. Obstet. Anesth. 1992; 1: 1172–9.Google Scholar
Kathirvel, S., Chavan, S., Arya, V. K.et al. Anesthetic management of patients with Takayasu's arteritis: a case series and review. Anesth. Analg. 2001; 93: 60–5.Google Scholar
Coel, M., Saito, R. & Endo, P. M.Use of magnetic resonance imaging in the diagnosis of Takayasu's arteritis during pregnancy: a case report. Am. J. Perinatol. 1993; 10: 126–9.Google Scholar
Wang, Y. M., Mak, G. Y., Lai, K. N. & Lui, S. F.Treatment of Takayasu's aortitis with percutaneous transluminal angioplasty and wall stent – a case report. Angiology 1998; 49: 945–9.Google Scholar
Nollen, G. & Mulder, B. J.What is new in the Marfan syndrome?Int. J. Cardiol. 2004; 97: S103–8.Google Scholar
Pyeritz, R. E. & McKusick, V. A.The Marfan syndrome: diagnosis and management. N. Engl. J. Med. 1979; 300: 772–7.Google Scholar
Elkayam, U., Ostrzega, E., Shotan, A. & Mehra, A.Cardiovascular problems in pregnant women with the Marfan syndrome. Ann. Intern. Med. 1995; 123:117–22.Google Scholar
Habashi, J. P., Judge, D. P., Holm, T. M.et al. Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science 2006; 312: 36–7.Google Scholar
Pyeritz, R. E. & Wappel, M. A.Mitral valve dysfunction in the Marfan syndrome. Clinical and echocardiographic study of prevalence and natural history. Am. J. Med. 1983; 74: 797–807.Google Scholar
Wells, D. G. & Podolakin, W.Anaesthesia and Marfan's syndrome: case report. Can. J. Anaesth. 1987; 34: 311–14.Google Scholar
Kim, S. Y., Martin, N., Hsia, E. C., Pyeritz, R. E. & Albert, D.A Management of aortic disease in Marfan syndrome: a decision analysis. Arch. Int. Med. 2005; 165: 749–55.Google Scholar
Krause, K. J.Marfan syndrome: literature review of mortality studies. J. Insur. Med. 2000; 32: 79–88.Google Scholar
Meijboom, L. J., Drenthen, W., Pieper, P. G.et al. Obstetric complications in Marfan syndrome. Int. J. Cardiol. 2006; 110(1): 53–9.Google Scholar
Gordon, C. F., 3rd & Johnson, M. D.Anesthetic management of the pregnant patient with Marfan Syndrome. J. Clin. Anesth. 1993; 5: 248–51.Google Scholar
Pumphrey, C. W., Fay, T. & Weir, I.Aortic dissection during pregnancy. Br. Heart J. 1986; 55: 106–8.Google Scholar
Fujitani, S. & Baldisseri, M. R.Hemodynamic assessment in a pregnant and peripartum patient. Crit. Care Med. 2005; 33: 5354–61.Google Scholar
Rahman, J., Rahman, F. Z., Rahman, W., al-Suleiman, S. A. & Rahman, M. S.Obstetric and gynecologic complications in women with Marfan syndrome. J. Reprod. Med. 2003; 48: 723–8.Google Scholar
Meijboom, L. J., Vos, F. E., Timmermans, J.et al. Pregnancy and aortic root growth in the Marfan syndrome: a prospective study. Eur. Heart J. 2005; 26: 914–20.Google Scholar
Pyeritz, R E.Maternal and fetal complications of pregnancy in the Marfan syndrome. Am. J. Med. 1981; 71: 784–90.Google Scholar
www.uhrad.com/ctarc/ct187.htm (accessed May 2006).
Sommer, T.Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology 1996; 199: 347–52.Google Scholar
Kaaja, R. J. & Greer, I. A.Manifestations of chronic disease during pregnancy. J.A.M.A. 2005; 294: 2751–7.Google Scholar
Sakaguchi, M., Kitahara, H., Seto, T.et al. Surgery for acute type A aortic dissection in pregnant patients with Marfan syndrome. Eur. J. Cardiothorac. Surg. 2005; 28: 280–3.Google Scholar
Lipscomb, K. J., Smith, J. C., Clarke, B., Donnai, P. & Harris, R.Outcome of pregnancy in women with Marfan's syndrome. Br. J. Obstet. Gynecol. 1997; 104: 201–6.Google Scholar
Rosenblum, N. G., Grossman, A. R., Gabbe, S. G., Mennuti, M. T. & Cohen, A. W.Failure of serial echocardiographic studies to predict aortic dissection in a pregnant patient with Marfan's syndrome. Am. J. Obstet. Gynecol. 1983; 14: 470–1.Google Scholar
Rossiter, J. P., Repke, J. T., Morales, A. J.et al. A prospective longitudinal evaluation of pregnancy in the Marfan syndrome. Am. J. Obstet. Gynecol. 1995; 173: 1599–606.Google Scholar
Okamoto, M., Hayatsu, K., Tomita, M. & Shimoji, K.Continuous epidural analgesia with intensive monitoring of cardiovascular system for vaginal delivery in a patient with Marfan's syndrome. Masui 2002; 51: 916–20.Google Scholar
Ferguson, J. E., 2nd, Ueland, K., Stinson, E. B. & Maly, R. P.Marfan's syndrome: acute aortic dissection during labor, resulting in fetal distress and cesarean section, followed by successful surgical repair. Am. J. Obstet. Gynecol. 1983; 147: 759–62.Google Scholar
Kamata, K., Morioka, N., Nomura, M. & Ozaki, M.Short-acting beta 1-adrenergic blocker is useful for anesthetic management of cesarean section in a patient with Marfan syndrome. Masui 2004; 53: 298–301.Google Scholar
Chow, S. L.Acute aortic dissection in a patient with Marfan's syndrome complicated by gestational hypertension. Med. J. Aust. 1993; 159: 760–2.Google Scholar
Tritapepe, L., Voci, P., Pinto, G., Brauneis, S. & Menichetti, A.Anaesthesia for caesarean section in a Marfan patient with recurrent aortic dissection. Can. J. Anaesth. 1996; 43: 1153–5.Google Scholar
Brar, H. B.Anaesthetic management of a caesarean section in a patient with Marfan's syndrome and aortic dissection. Anaesth. Intensive Care 2001; 29: 67–70.Google Scholar
Pinosky, M. L., Hopkins, R. A., Pinckert, T. L. & Suyderhoud, J. P.Anesthesia for simultaneous cesarean section and acute aortic dissection repair in a patient with Marfan's syndrome. J. Cardiothorac. Vasc. Anesth. 1994; 8: 451–4.Google Scholar
Hobbs, W. R., Sponseller, P. D., Weiss, A. P. & Pyeritz, R. E.The cervical spine in Marfan syndrome. Spine 1997; 22: 983–9.Google Scholar
Foran, J. R., Pyeritz, R. E., Dietz, H. C. & Sponseller, P. D.Characterization of the symptoms associated with dural ectasia in the Marfan patient. Am. J. Med. Genet. A 2005; 134: 58–65.Google Scholar
Lacassie, H. J., Millar, S., Leithe, L. G.et al. Dural ectasia: a likely cause of inadequate spinal anaesthesia in two parturients with Marfan's syndrome. Br. J. Anaesth. 2005; 94: 500–4.Google Scholar
Kato, R., Terui, K., Yokota, C.et al. Anesthetic management for cesarean section in Moyamoya disease: a report of five consecutive cases and a mini-review. Int. J. Obstet. Anesth. 2006; 15: 152–8.Google Scholar
Iwama, T., Morimoto, M., Hashimoto, N.et al. Mechanism of intracranial rebleeding in Moyamoya disease. Clin. Neurol. Neurosurg. 1997; 99: S187–90.Google Scholar
Abouleish, E., Wiggins, M. & Ali, V.Combined spinal and epidural anesthesia for cesarean section in a parturient with Moyamoya disease. Acta Anaesthesiol. Scand. 1998; 42: 1120–3.Google Scholar
Kee, Ngan W. D. & Gomersall, C. D.Extradural anaesthesia for caesarean section in a patient with Moyamoya disease. Br. J. Anaesth. 1996; 77: 550–2.Google Scholar
Smiley, R. M., Ridley, D. M., Hartmann, A., Ciliberto, C. F. & Baxi, L.Transcranial Doppler blood flow measurement during cesarean section in two patients with cerebral vascular disease. Int. J. Obstet. Anesth. 2002; 11: 211–15.Google Scholar
Sharma, S. K., Wallace, D. H., Sidawi, J. E. & Gambling, D. R.Obstetric anaesthesia and moyamoya disease. Can. J. Anaesth. 1994; 41: 756–7.Google Scholar
Yeung, R. S.Pathogenesis and treatment of Kawasaki's disease. Curr. Opin. Rheumatol. 2005; 17: 566–7.Google Scholar
Tsuda, E., Kawamata, K., Neki, R., Echigo, S. & Chiba, Y.Nationwide survey of pregnancy and delivery in patients with coronary arterial lesions caused by Kawasaki disease in Japan. Cardiol. Young. 2006; 16: 173–8.Google Scholar
Hayakawa, H. & Katoh, T.Successful pregnancy after coronary artery bypass grafting for Kawasaki disease. Acta Paediatr. Jpn. 1998; 40: 275–7.Google Scholar
Arakawa, K., Akita, T., Nishizawa, K.et al. Anticoagulant therapy during successful pregnancy and delivery in a Kawasaki disease patient with coronary aneurysm – a case report. Jpn. Circ. J. 1997; 61: 197–200.Google Scholar
Alam, S., Sakura, S. & Kosaka, Y.Anaesthetic management for caesarean section in a patient with Kawasaki disease. Can. J. Anaesth. 1995; 42: 1024–6.Google Scholar
McAndrew, P., Hughes, D. & Adams, P.Pregnancy and Kawasaki disease. Int. J. Obstet. Anesth. 2000; 9: 279–81.Google Scholar
Dob, D. P. & Yentis, S. M.Practical management of the parturient with congenital heart disease. Int. J. Obstet. Anesth. 2006; 15: 137–44.Google Scholar
Rebarber, A., Roman, A. S., Roshan, D. & Biel, F.Obstetric management of Klippel-Trenaunay syndrome. Obstet. Gynecol. 2004; 104: 1205–8.Google Scholar
Lorda-Sanchez, I., Prieto, L., Rodriguez-Pinilla, E. & Martinez-Frias, M. L.Increased parental age and number of pregnancies in Klippel-Trenaunay-Weber syndrome. Ann. Hum. Genet. 1998; 62: 235–9.Google Scholar
Ceballos-Quintal, J. M., Pinto-Escalante, D. & Castillo-Zapata, I.A new case of Klippel-Trenaunay-Weber (KTW) syndrome: evidence of autosomal dominant inheritance. Am. J. Med. Genet. 1996; 63: 426–7.Google Scholar
Timur, A. A., Driscoll, D. J. & Wang, Q.Biomedicine and diseases: the Klippel-Trenaunay syndrome, vascular anomalies and vascular morphogenesis. Cell Mol. Life Sci. 2005; 62: 1434–47.Google Scholar
Linge, C. & Prager, T. M.TMJ morphology and function in a patient with Klippel-Trenaunay syndrome. Case report. J. Orofac. Orthop. 2000; 61: 217–21.Google Scholar
Sella, E. J. & Ortega, G. R.Charcot osteoarthropathy in a case of Klippel-Trenaunay-Weber syndrome. Foot Ankle Int. 2003; 24: 801–4.Google Scholar
Yang, J. I., Kim, H. S. & Ryu, H. S.Prenatal sonographic diagnosis of Klippel-Trenaunay-Weber syndrome: a case report. J. Reprod. Med. 2005; 50: 291–4.Google Scholar
Warhit, J. M., Goldman, M. A., Sachs, L., Weiss, L. M. & Pek, H.Klippel-Trenaunay-Weber syndrome: appearance in utero. J. Ultrasound Med. 1983; 2: 515–18.Google Scholar
Hergesell, K., Kroger, K., Petruschkat, S.et al. Klippel-Trenaunay syndrome and pregnancy. Int. Angiol. 2003; 22: 194–8.Google Scholar
Watermeyer, S. R., Davies, N. & Goodwin, R. I.The Klippel-Trenaunay syndrome in pregnancy. B. J. O. G. 2002; 109: 1301–2.Google Scholar
Verheijen, R. H., Rijen-de Rooij, H. J., Zundert, A. A. & Jong, P. A.Pregnancy in a patient with the Klippel-Trenaunay-Weber syndrome: a case report. Eur. J. Obstet. Gynecol. Reprod. Biol. 1989; 33: 89–94.Google Scholar
Pollack, R. N., Quance, D. R. & Shatz, R. M.Pregnancy complicated by the Klippel-Trenaunay syndrome. A case report. J. Reprod. Med. 1995; 40: 240–2.Google Scholar
Richards, D. S. & Cruz, A. C.Sonographic demonstration of widespread uterine angiomatosis in a pregnant patient with Klippel-Trenaunay-Weber syndrome. J. Ultrasound Med. 1997; 16: 631–3.Google Scholar
Fait, G., Daniel, Y., Kupfermine, M. J.et al. Klippel-Trenaunay-Weber syndrome associated with fetal growth restriction. Hum. Reprod. 1996; 11: 2544–5.Google Scholar
Neubert, A. G., Golden, M. A. & Rose, N. C.Kasabach-Merritt coagulopathy complicating Klippel-Trenaunay-Weber syndrome in pregnancy. Obstet. Gynecol. 1995; 85: 831–3.Google Scholar
Gaiser, R. R., Cheek, T. G. & Gutsche, B. B.Major conduction anesthesia in a patient with Klippel-Trenaunay syndrome. J. Clin. Anesth. 1995; 7: 316–19.Google Scholar
Dobbs, P., Caunt, A. & Alderson, T. J.Epidural analgesia in an obstetric patient with Klippel-Trenaunay syndrome. Br. J. Anaesth. 1999; 82: 144–6.Google Scholar
Eastwood, D. W.Hematoma after epidural anesthesia: relation of skin and spinal angiomas. Anesth. Analg. 1991; 73: 352–4.Google Scholar
Popham, P. & Buettner, A.Arterial aneurysms of the lienorenal axis during pregnancy. Int. J. Obstet. Anesth. 2003; 12: 117–19.Google Scholar
Selo-Ojeme, D. O. & Welch, C. C.Review: spontaneous rupture of splenic artery aneurysm in pregnancy. Eur. J. Obstet. Gynecol. Reprod. Med. 2003; 109: 124–7.Google Scholar
Richardson, A. J., Bahlool, S. & Knight, J.Ruptured splenic artery aneurysm in pregnancy presenting in a manner similar to pulmonary embolus. Anaesthesia 2006; 61: 187–9.Google Scholar
Al Asfar, F., Saber, M., Dhar, P. M. & Al Awadhi, N.Rupture of splenic artery aneurysm during labor: a case report of maternal and fetal survival. Med. Princ. Pract. 2005; 14: 53–4.Google Scholar
James, A. H., Tapson, V. F. & Goldhaber, S. Z.Thrombosis during pregnancy and the postpartum period. Am. J. Obstet. Gynecol. 2005; 193: 216–19.Google Scholar
Walker, I. D.Venous and arterial thrombosis during pregnancy: epidemiology. Semin. Vasc. Med. 2003; 3: 25–32.Google Scholar
Walker, I. D.Arterial thromboembolism in pregnancy. Best Pract. Res. Clin. Haematol. 2003; 16: 297–310.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Vascular diseases
    • By David R. Gambling, Clinical Associate Professor, (non-salaried) Department, Anesthesiology, University of California San Diego, CA USA; Staff Anesthesiologist, Sharp Mary Birch Hospital for Women
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.004
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Vascular diseases
    • By David R. Gambling, Clinical Associate Professor, (non-salaried) Department, Anesthesiology, University of California San Diego, CA USA; Staff Anesthesiologist, Sharp Mary Birch Hospital for Women
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.004
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Vascular diseases
    • By David R. Gambling, Clinical Associate Professor, (non-salaried) Department, Anesthesiology, University of California San Diego, CA USA; Staff Anesthesiologist, Sharp Mary Birch Hospital for Women
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.004
Available formats
×