{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T10:00:16Z","timestamp":1785578416012,"version":"3.56.0"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pregnancy in women with Marfan syndrome markedly increases the risk of life-threatening aortic complications due to superimposed haemodynamic and hormonal stress on an intrinsically fragile aortic wall. Management becomes particularly challenging when a giant aortic root or ascending aortic aneurysm with severe aortic regurgitation is diagnosed during early pregnancy before fetal viability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 19-year-old primigravid woman at 15 weeks and 2 days of gestation with known Marfan syndrome presented with persistent palpitations. Evaluation revealed a giant fusiform aneurysm involving the aortic root and ascending aorta measuring 69\u2005mm on transthoracic echocardiography and \u223c9\u201310\u2005cm intraoperatively, severe aortic regurgitation due to annular dilation, and left ventricular systolic dysfunction with an ejection fraction of 40%\u201342%. Following multidisciplinary consultation and counselling regarding maternal and fetal risks, urgent surgical intervention was undertaken without termination of pregnancy. The patient underwent an emergency Bentall procedure. The perioperative course was complicated by major bleeding requiring delayed sternal closure and transfusion support. Post-operative echocardiography demonstrated a functioning mechanical prosthesis with acceptable haemodynamics and persistent severe left ventricular systolic dysfunction with an ejection fraction of 25%\u201330%. Obstetric ultrasonography confirmed a viable fetus. The patient was discharged in stable condition on post-operative day 11.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case demonstrates that emergency aortic root replacement during early second-trimester pregnancy may be lifesaving in selected patients with Marfan syndrome and severe aortic pathology when guided by multidisciplinary coordination and meticulous perioperative management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag554","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T11:31:22Z","timestamp":1785065482000},"source":"Crossref","is-referenced-by-count":0,"title":["Emergency Bentall procedure at 15 weeks\u2019 gestation for giant aortic root aneurysm in Marfan syndrome: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0406-8670","authenticated-orcid":false,"given":"Mehran","family":"Mottahedi","sequence":"first","affiliation":[{"name":"Department of Surgical and Interventional Sciences, Faculty of Medicine, McGill University , 1650 Cedar Avenue, Montreal QC H3G 1A4 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0298-6830","authenticated-orcid":false,"given":"Setareh","family":"Garousi","sequence":"additional","affiliation":[{"name":"Department of Surgical and Interventional Sciences, Faculty of Medicine, McGill University , 1650 Cedar Avenue, Montreal QC H3G 1A4 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahdi","family":"Kahrom","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences , Ahmadabad Avenue, Mashhad 9176699199 ,","place":["Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8222-4285","authenticated-orcid":false,"given":"Behrooz","family":"Mottahedi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences , Ahmadabad Avenue, Mashhad 9176699199 ,","place":["Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"2026080105360636800_ytag554-B1","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1016\/S0140-6736(05)67789-6","article-title":"Marfan\u2019s syndrome","volume":"366","author":"Judge","year":"2005","journal-title":"Lancet"},{"key":"2026080105360636800_ytag554-B2","doi-asserted-by":"crossref","first-page":"51","DOI":"10.14797\/mdcvj.1371","article-title":"The impact of pregnancy in patients with thoracic aortic disease: epidemiology, risk assessment, and management considerations","volume":"20","author":"Duarte","year":"2024","journal-title":"Methodist Debakey Cardiovasc J"},{"key":"2026080105360636800_ytag554-B3","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"Circulation"},{"key":"2026080105360636800_ytag554-B4","doi-asserted-by":"crossref","first-page":"4462","DOI":"10.1093\/eurheartj\/ehaf193","article-title":"2025 ESC guidelines for the management of cardiovascular disease and pregnancy","volume":"46","author":"De Backer","year":"2025","journal-title":"Eur Heart J"},{"key":"2026080105360636800_ytag554-B5","first-page":"140","article-title":"Emergent cardiac surgery with cardiopulmonary bypass in early pregnancy: report of four cases","volume":"2","author":"Ngo Nonga","year":"2013","journal-title":"Res Cardiovasc Med"},{"key":"2026080105360636800_ytag554-B6","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2025.1637826","article-title":"Management of cardiopulmonary bypass in pregnancy: challenges and progress in maternal-fetal protection","volume":"12","author":"Dong","year":"2025","journal-title":"Front Cardiovasc Med"},{"key":"2026080105360636800_ytag554-B7","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13019-022-01754-5","article-title":"Left ventricle reverse remodeling in chronic aortic regurgitation patients with dilated ventricle after aortic valve replacement","volume":"17","author":"Zhang","year":"2022","journal-title":"J Cardiothorac Surg"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag554\/70154966\/ytag554.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/8\/ytag554\/70154966\/ytag554.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/8\/ytag554\/70154966\/ytag554.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T09:36:14Z","timestamp":1785576974000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag554\/8742228"}},"subtitle":[],"editor":[{"given":"Edoardo","family":"Zancanaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Noor Mohamed Ghassan Mohamed Adnan","family":"Shaikho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Muhammad Junaid","family":"Ahsan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Firas","family":"Al-Obaidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Muhammad Asim","family":"Shabbir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":7,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,7,31]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag554","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,27]]},"article-number":"ytag554"}}