Thorac Cardiovasc Surg 2016; 64(02): 133-136
DOI: 10.1055/s-0035-1549111
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Aortic Dissections Type A during Sexual Intercourse in Male Patients: Accident or Systematic Coincidence? Examination of 365 Patients with Acute Aortic Dissection within 20 Years

Laura Gansera
1  Department of Cardiology, Klinikum Augsburg, Augsburg, Germany
,
Oliver Deutsch
2  Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany
,
Larissa Szameitat
2  Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany
,
Walter Eichinger
2  Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany
,
Brigitte Gansera
2  Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany
› Author Affiliations
Further Information

Publication History

03 October 2014

31 December 2014

Publication Date:
18 March 2015 (online)

Abstract

Objectives Physical exercise accompanied by arterial hypertension is known to trigger acute aortic dissections. As a booster effect, mental stress leads to aggravation of hypertensive crisis. The aim of the study was to evaluate whether stress factors during sexual intercourse play any role as a catalyst in patients with acute type A aortic dissections. Concerning this subject, only two case reports have been published.

Methods A total of 365 patients with acute type A aortic dissections, operated between January 1993 and July 2014, were analyzed retrospectively. The main focus was to identify the provoking situation before onset of symptoms. A total of 247 patients were males and mean age was 60.2 years (range, 17.0–91.9 years). Of the total cohort, 86 patients (24%) were younger than 50 years (68 males) and 184 patients (50%) were younger than 60 years (149 males).

Results The explicit trigger could not be determined in 24% of the patients. In majority of the patients, onset of symptoms occurred during physical exercises, such as sports or lifting of heavy weights (68%), without a significant difference between males and females. In only 8% of the patients, symptoms occurred at rest. In 0.9%, Marfan syndrome was evident. Eleven of 68 males < 50 years (16%) and 17 of 149 males < 60 years (11%) but none among females (p = 0.03) experienced sudden onset of symptoms during sexual intercourse.

Conclusion Combined physical and emotional stress during sexual intercourse seems to present a meaningful promoter effect for acute aortic dissections, especially in younger males, but not in females. Despite self-evidence of this phenomenon, frequency of this sensitive issue appears to be surprisingly high.