Erschienen in:
19.01.2024 | Images
Severe dural ectasia in a pregnant patient with Marfan syndrome
verfasst von:
Javiera P. Vargas Zúñiga, MD, Ronald B. George, MD FRCPC
Erschienen in:
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
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Ausgabe 4/2024
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Excerpt
A 36-yr-old parturient (G1P0) at 37 +4 weeks gestation with a known history of Marfan syndrome (MS) presented for Cesarean delivery. The parturient’s MS was evident with aortopathy in the ascending aorta of 38 mm measured via transthoracic echocardiography and of 40 mm via magnetic resonance imaging (MRI), mild mitral regurgitation, mild scoliosis, and pectus excavatum. A pelvis and abdominal MRI early in the pregnancy showed remarkable dural ectasia in the lumbar spine and sacrum. This is one of the major criteria for MS and has been defined as an enlargement of the neural canal anywhere along the spinal column, but nearly always in the lower lumbar and sacral regions; widening of the neural foramina; or an anterior meningocele.
1 The prevalence in adults with MS is up to 89%.
2 Dural ectasia has been related to equivocal spread of local anesthetic in spinal anesthesia,
3 and is also associated with a higher risk of accidental dural puncture with epidural needles in some case reports.
4 …