title: Emergency cesarean section due to acute aortic dissection type A (Debakey I) without Marfan syndrome: a case report and review of the literature.
abstract: BACKGROUND
  Acute aortic dissection during pregnancy is an uncommon but important emergency due to its lethal risk to both mother and child. The dissection usually involves the ascending aorta or the aortic arch. Although additional affection of the descending aorta up to bifurcation is possible, further increasing the risk of organ malperfusion, full-length aortic dissection (DeBakey I) is known to be very rare. Dissection during pregnancy has been reported predominantly in combination with Marfan syndrome. Acute aortic dissection Stanford type A (AADA) DeBakey I during pregnancy without signs of Marfan syndrome as a warning signal is very uncommon in the current literature.
  
  
  OBJECTIVE
  The etiology, diagnosis, differential diagnosis, and management of this rare disease are discussed in relation to the current literature.
  
  
  METHODS
  We report the case of an athletic 34-year-old woman in the third trimester of pregnancy, without history of previous diseases, who presented to our Emergency Department after collapsing. In the resuscitation department, an emergency cesarean section was performed due to the start of circulation failure in the mother. Computed tomography scan revealed a severe aortic dissection starting from 1 cm distal the aortic valve over the full length up to the iliac arteries, involving the brachiocephalic and carotid arteries up to the level of the larynx. Emergency replacement of the ascending aorta and the aortic arch was performed. Both the mother and baby survived and were doing well 1 year postoperatively.
  
  
  CONCLUSIONS
  This alarming result of AADA (DeBakey I) in late pregnancy without obvious warnings such as Marfan syndrome illustrates the importance of performing early imaging in similar cases.
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Beirer
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Ingo J
authors.initials: IJ
authors.lastname: Banke
authors.affiliation: Institute of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Münzel
authors.affiliation: Clinic for Vascular and Endovascular Surgery, Interdisciplinary Center for Vascular Diseases, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Wendorff
authors.affiliation: Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Nawid
authors.initials: N
authors.lastname: Khaladj
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Chlodwig
authors.initials: C
authors.lastname: Kirchhoff
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Huber-Wagner
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Biberthaler
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D006801:Humans; D008382:Marfan Syndrome; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000601:surgery*; D011263:Pregnancy Trimester, Third; D011859:Radiography
keywords: Emergency Department; acute aortic dissection type A (AADA); aortic replacement; cesarean section; pregnancy