title: Acute type A aortic dissection and pregnancy: a population-based study.
abstract: OBJECTIVE
  Pregnancy has been reported to be an independent risk factor for 50% of acute aortic dissections recorded in women younger than 45 years of age. The present epidemiologic study aimed to identify whether this putative association of pregnancy and acute type A dissection could be an artifact of selective reporting.
  
  
  METHODS
  This population-based study was conducted in the City of Vienna, Austria, Europe, in an average female population of 34,1381 women in the age range of 15-45 years who were followed up between 1994 and 2004 (total of 3755.195 person-years of observation). During this study, the incidence, management, and outcome of acute type A dissection were determined.
  
  
  RESULTS
  Fifteen patients (mean age: 38.8 years, SD: 4.8) with acute aortic dissection were identified, and an overall incidence of 0.4 case per 100000 person-years was estimated. The prehospital mortality rate was recorded to be 53%. Six patients, including two women in late pregnancy (incidence: 0.05 cases per 100000 person-years), were treated successfully by surgical repair during deep hypothermic circulatory arrest (in-hospital mortality rate: 6.6%). Pregnancy and aortic dissection were identified as events that were not related (RR: 3.27; 95% confidence interval (CI): 0.82-12.95; P=0.14). Observation during long-term follow-up was uneventful.
  
  
  CONCLUSIONS
  Acute aortic dissection represents a rare pathology in women younger than 45 years of age; however, it is associated with a high rate of sudden death. Pregnancy may not be a risk factor for this life-threatening vascular emergency. Immediate referral to surgery, even during pregnancy, will result in a prognosis of favorable outcome.
authors.affiliation: Department of Cardiovascular Surgery, Lainz Hospital, Vienna, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Thalmann
authors.forename: Gottfried H
authors.initials: GH
authors.lastname: Sodeck
authors.forename: Hans
authors.initials: H
authors.lastname: Domanovits
authors.forename: Martin
authors.initials: M
authors.lastname: Grassberger
authors.forename: Christian
authors.initials: C
authors.lastname: Loewe
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D001317:Austria / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000601:surgery; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult