Clinical aspects
The patient is a 40-year-old female with aortic dissection, hypovolemic shock and death. She had arterial hypertension and HELLP syndrome in pregnancy, which is characterized by hemolysis, increased liver enzymes and low platelet count.
The following are considered risk factors for aortic dissection: a) arterial hypertension; b) Marfan’s syndrome; c) bicuspid aortic valve; d) Turner’s syndrome; e) pregnancy. In a study on the postmortem examinations performed at InCor between 1998 and 2007, 82 cases of aortic dissection were diagnosed. Most dissections were associated with other diseases, mainly arterial hypertension present in 73/82 cases (90%). Other diseases related were Marfan’s syndrome, other connective tissue diseases, bicuspid aortic valve and trauma related to thoracic surgeries. Another study assessing the postmortem examination of 161 patients with aortic dissection has reported arterial hypertension in 93/161 (57.7%) cases. Other causes found were Marfan’s syndrome (16 cases), atherosclerosis of the aorta (38) and degeneration of the aorta (30). Other less prevalent risk factors were bicuspid aortic valve, Turner’s syndrome, aortic coarctation and pregnancy. However, the likelihood of aortic dissection due to aortic coarctation is related to the coexistence of arterial hypertension or congenital bicuspid aortic valve. Although pregnancy is considered a spontaneous risk factor for aortic dissection, that mechanism is uncommon, being 25% to 50% of the cases concomitantly associated with hypertension.
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