Aortic dissection: pregnancy could be a predisposing factor.

Clinical bottom line (level 5)

  1. Pregnancy may be a risk factor for aortic dissection.
  2. Antihypertensive treatments should be given urgently.
  3. Surgery should be considered with acute dissection of the ascending or descending aorta, or in chronic dissection with the aorta > 5-6 cm or symptoms.
DeSanctis et al: New England Journal of Medicine 1987; 317 (17): 1060-1067
Expires December 2004

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: non-systematic review of aortic dissection, including case data

0 patients aortic dissection



Outcomes studied:

The evidence


  • Predisposing factors of aortic dissection:
    • pregnancy (half of all dissections in women under 40 occur during pregnancy, usually the third trimester)
    • Marfan's syndrome
    • Ehlers-Danlos syndrome
    • congenitally bicuspid and unicommissural aortic valves and aortic coarctation
    • male
  • Aortic dissection had also been reported in association with:
    • Turner's syndrome
    • Noonan' syndrome
    • giant cell aortitis
    • systemic lupus
    • relapsing polychondritis
  • Antihypertensive treatment must be given urgently. Options include:
    • iv sodium nitroprusside and propranolol iv
    • trimethaphan iv
    • labetalol iv
  • Surgery should be considered with:
    • acute dissection of ascending aorta
    • acute dissection of descending aorta
    • chronic dissection, if aorta is more than 5-6 cm in diameter, or there are symptoms

Comments

  1. This paper is a narrative review; a summary of clinical experience with some supportive evidence.
  2. The field of evidence-based aortic dissection is scant. This review was used as a bibliographic resource.

Citation

  1. DeSanctis RW, Doroghazi RM, Austen WG, et al: Aortic dissection. New England Journal of Medicine 1987; 317 (17): 1060-1067
Contributor: Clare Wotton and Bob Phillips, December 2000
Reviewer: Bob Phillips

Clinical Question.
Patient aortic dissection
Intervention or Exposure
Outcome diagnosis and therapy