Acute aortic dissection – an unexpected cause of death of a young pregnant woman. Case report

Overview

Acute aortic dissection is a relatively rare life-threatening condition in which blood penetrates through a tear in the tunica intima into the vessel wall, splits it longitudinally and forms a false lumen. Although this condition usually affects patients in the 5th and 6th decade, it can rarely occur at a young age. Due to hemodynamic and hormonal changes in pregnancy, up to half of dissections in women younger than 40 years occur just during pregnancy. Risk factors for acute aortic dissection include arterial hypertension, genetic syndromes associated with connective tissue disorders, or developmental defects of the aortic valve.

In this case report, we present a case of unexpected death of a 34-year-old woman in the third trimester of gravidity in whom the autopsy revealed an acute aortic dissection. This woman suffered from hypertension, which is one of the main risk factors for acute aortic dissection. Although histological examination of the aorta did not clearly show chronic changes in the vessel wall, it can be assumed, based on the current literature data, that hypertension combined with hemodynamic and hormonal changes during gravidity was the cause of this fatal condition. Concomitant use of triptans and selective serotonin reuptake inhibitors (SSRI) may have contributed to the decompensation of hypertension. However, clinical data on the use of these drugs were found out a long time after the autopsy and it was not possible to perform toxicological examination to confirm this suspicion.

Keywords:

aortic dissection – type A – pregnancy – sudden death