Elsevier

Current Surgery

Volume 58, Issue 3, May–June 2001, Pages 316-318
Current Surgery

Original report
Successful surgical treatment of spontaneous coronary artery dissection

https://doi.org/10.1016/S0149-7944(00)00456-6Get rights and content

Abstract

To present a case of spontaneous coronary artery dissection (SCAD). Spontaneous coronary artery dissection is rare and often difficult to surgically repair. Additionally, diagnosis by coronary angiography is uncommon. We present a case of SCAD in a postpartum woman who underwent successful surgical correction of the left anterior descending artery. Such surgical intervention in cases similar to ours is critical for survival.

Introduction

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction. It occurs in younger populations and has a predilection for women.1, 2, 3 Three major groups have been associated with SCAD: patients with atherosclerotic coronary artery disease, women in the postpartum period, and idiopathic causes.2 Coronary artery dissection is often fatal, with approximately 75% of cases diagnosed at autopsy.2, 4 The origin, pathogenesis, diagnosis, and treatment remain unclear. Both medical and surgical treatments exist; however, coronary artery bypass grafting has been commonly recommended.2 We present the case of SCAD in a postpartum woman with chest pain who underwent successful coronary artery bypass surgery.

Section snippets

Case report

A 37-year-old Caucasian woman presented to the emergency room with sudden onset of chest pain. She had no prior history of cardiovascular disease, trauma, or collagen tissue disease. Surgical history was pertinent for laparoscopic removal of an ovarian cyst and an abortion. At the time of presentation, the patient was 4 days postpartum from the delivery of her second child. She smoked 1 pack of cigarettes per day and drank alcohol minimally. She was taking no medications and was not on oral

Discussion

Spontaneous coronary artery dissection is a rare cause of myocardial infarction and is often fatal. Approximately 50% of patients with coronary artery dissection die abruptly and 18% to 20% die within hours.4 Spontaneous dissection of the coronary vasculature is less likely to occur than is secondary to blunt trauma, associated with aortic dissection, associated with collagen vascular disorders such as Marfan’s syndrome, sarcoidosis, angiitis, previous renal transplantation, or iatrogenic cases.

References (12)

  • P.A. Thistlethwaite et al.

    Surgical management of spontaneous left main coronary artery dissection

    Ann Thorac Surg

    (1998)
  • S.J. DeMaio et al.

    Clinical course and long-term prognosis of spontaneous coronary artery dissection

    Am J Cardiol

    (1989)
  • J.O. Thayer et al.

    Spontaneous coronary artery dissection

    Ann Thorac Surg

    (1987)
  • P. Zampieri et al.

    Follow up after spontaneous coronary artery dissectiona report of five cases

    Heart

    (1996)
  • P. Cocco et al.

    Ematoma (aneurisma) dissecante spontaneo delle coronarie e morte improvvisa

    G Ital Cardiol

    (1990)
  • T. Koga et al.

    Circumferential spontaneous coronary dissection in an elderly mana case report

    Angiology

    (1998)
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