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 Mrs Neama M. 31 years old has a Marfan syndrome, Her father and brother underwent aortic root replacement. She desired to be pregnant. The dilatation of aorta was 44 mm with mild aortic regurgitation. The mitral regurgitation was moderate to severe with normal arterial pressure. After concertation, the pregnancy was not allowed until the repair of aortic aneurysm. The patient underwent repair of pectus excavatum in 2015. In 2016, she underwent aortic valve replacement with valve sparing and repair of mitral valve. In 2017, she developed severe shortness of breath and fever. The echocardiogram showed dramatic increase of aortic regurgitation, a thrombus in left appendage. The serology of Barthonella and q fever was positive. The treatment antibiotic was immediately given without any improvement. The surgical treatment was denied because high surgical risk due to the precarious hemodynamic condition. According to the heart team decision, N. underwent aortic valve replacement by Transcutaneous valve implantation. The shortness of breath disappeared, the left ventricular function, the clot disappeared and the clinical status improved. She is allowed to become pregnant.
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