Pregnancy-associated spontaneous coronary artery dissection: multidisciplinary management, challenges and literature review

2021 ◽  
Vol 14 (12) ◽  
pp. e244851
Author(s):  
Nnadozie Igbokwe ◽  
Jess Gomersall ◽  
Sunday Paul Ugwoke ◽  
Sean Esmonde
Keyword(s):  
Coronary Artery ◽  
Troponin T ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Vein Grafts ◽  
Severe Impairment ◽  
Obtuse Marginal

A 30-year-old woman in her second pregnancy, which was complicated by gestational diabetes mellitus. She had an uneventful spontaneous vaginal delivery at 38 weeks+3 days of gestation. Day 1 postpartum, she developed sudden chest pain radiating to her jaw and neck. Her observations were normal, and ECG showed lateral ST elevation in keeping with acute myocardial infarction. The troponin-T level was elevated at 21 ng/L at 0 hour, and >10 000 ng/L at 12 hours, respectively. Coronary angiography confirmed spontaneous dissection of the proximal left anterior descending (LAD) and proximal circumflex coronary arteries. She became unstable during percutaneous coronary intervention and consequently had a successful coronary artery bypass surgery with left saphenous vein grafts to the first obtuse marginal artery and LAD. Echocardiogram revealed moderate to severe impairment of the left ventricular function postoperatively.

scholarly journals Risks and benefits of percutaneous coronary intervention in spontaneous coronary artery dissection

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318914
Author(s):  
Deevia Kotecha ◽  
Marcos Garcia-Guimaraes ◽  
Diluka Premawardhana ◽  
Dario Pellegrini ◽  
Clare Oliver-Williams ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Timi Flow ◽  
Percutaneous Coronary

ObjectiveTo investigate percutaneous coronary intervention (PCI) practice in an international cohort of patients with spontaneous coronary artery dissection (SCAD). To explore factors associated with complications and study angiographic and longer term outcomes.MethodsSCAD patients (n=215, 94% female) who underwent PCI from three national cohort studies were investigated and compared with a matched cohort of conservatively managed SCAD patients (n=221).ResultsSCAD-PCI patients were high risk at presentation with only 8.8% undergoing PCI outside the context of ST-elevation myocardial infarction/cardiac arrest, thrombolysis in myocardial infarction (TIMI) 0/1 flow or proximal dissections. PCI complications occurred in 38.6% (83/215), with 13.0% (28/215) serious complications. PCI-related complications were associated with more extensive dissections (multiple vs single American Heart Association coronary segments, OR 1.9 (95% CI: 1.06–3.39),p=0.030), more proximal dissections (proximal diameter per mm, OR 2.25 (1.38–3.67), p=0.001) and dissections with no contrast penetration of the false lumen (Yip-Saw 2 versus 1, OR 2.89 (1.12–7.43), p=0.028). SCAD-PCI involved long lengths of stent (median 46mm, IQR: 29–61mm). Despite these risks, SCAD-PCI led to angiographic improvements in those with reduced TIMI flow in 84.3% (118/140). Worsening TIMI flow was only seen in 7.0% (15/215) of SCAD-PCI patients. Post-PCI major adverse cardiovascular and cerebrovascular events (MACCE) and left ventricular function outcomes were favourable.ConclusionWhile a conservative approach to revascularisation is favoured, SCAD cases with higher risk presentations may require PCI. SCAD-PCI is associated with longer stent lengths and a higher risk of complications but leads to overall improvements in coronary flow and good medium-term outcomes in patients.

scholarly journals Spontaneous, Postpartum Coronary Artery Dissection and Cardiogenic Shock with Extracorporeal Membrane Oxygenation Assisted Recovery in a 30-Year-Old Patient

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Kathleen E. Knapp ◽  
Ricardo A. Weis ◽  
Efrain I. Cubillo ◽  
Alyssa B. Chapital ◽  
Harish Ramakrishna
Keyword(s):  
Coronary Artery ◽  
Extracorporeal Membrane Oxygenation ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Membrane Oxygenation ◽  
Biventricular Failure ◽  
Va Ecmo

Coronary artery dissection is an infrequent cause of acute coronary syndrome in the general population. There is, however, a greater incidence of spontaneous coronary artery dissection (SCAD) in young women, especially in the peripartum period. However, the majority of cases have favorable outcomes with medical management or percutaneous coronary intervention; coronary artery bypass grafting (CABG) and transplantation are utilized in severe cases. This case is a one of a 30-year-old postpartum female with multivessel SCAD requiring CABG with subsequent biventricular failure and inability to wean from bypass. We believe this is the first reported case in which venoarterial extracorporeal membrane oxygenation (VA-ECMO) was used in the management of biventricular heart failure in a postpartum patient with SCAD.

scholarly journals Multiple spontaneous coronary artery dissections associated with intravenous daunorubicin treatment for acute myelocytic leukaemia: a case report

2020 ◽  
Author(s):  
Do Van Chien ◽  
Pham Dang Hai ◽  
Le Thi Nhung ◽  
Pham Truong Son
Keyword(s):  
Coronary Artery ◽  
Rare Condition ◽  
Artery Dissection ◽  
Second Phase ◽  
Coronary Artery Dissection ◽  
Coronary Catheterization ◽  
Myelocytic Leukaemia ◽  
Obtuse Marginal ◽  
Induction Cycle ◽  
Acute Myelocytic Leukaemia

Abstract Background Multiple spontaneous coronary artery dissection (SCAD) is a rare condition which may lead to serious consequences such as sudden cardiac death, acute myocardial infarction (AMI), and acute heart failure. Case summary In this paper, we report the case of a 57-year-old woman with acute myelocytic leukaemia who was undergoing her second phase of chemotherapy. After the first induction cycle of intravenous infusion of daunorubicin, the patient experienced chest pain, shortness of breath, and low blood pressure. The electrocardiograms revealed significant ST-elevation in the D1, aVL, and V2–V6 leads, which indicated AMI. Coronary catheterization showed spontaneous coronary dissection in the mid-left descending coronary artery and first obtuse marginal artery of the circumflex. The patient died immediately. Discussion This is the first reported case of multiple SCAD associated with intravenous (IV) daunorubicin infusion. We also reviewed the literature and proposed the mechanism of this complication.

Salvage myocardial revascularisation in spontaneous left main coronary artery dissection with cardiogenic shock – the role of mechanical circulatory support

Perfusion ◽  
2016 ◽  
Vol 32 (2) ◽  
pp. 171-173 ◽  
Author(s):  
Ashok Padukone ◽  
Ahmed K. Sayeed ◽  
Nandor Marczin ◽  
Diana García Sáez ◽  
Bartlomiej Zych ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Circulatory Support ◽  
Artery Dissection ◽  
Left Main ◽  
Coronary Artery Dissection

Spontaneous left main coronary artery dissection is a rare cause of acute coronary events or sudden cardiac death, constituting less than 1% of all epicardial coronary artery dissections. It is often fatal and is mostly recognized at post-mortem examination in young victims of sudden death. More than 70% of the reported cases occurred in women, particularly during pregnancy and the peripartum period and those on oral contraceptives. The clinical presentation is highly variable and prognosis varies widely, depending predominantly on the speed of diagnosis. Treatment options include medical therapy, revascularization with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and mechanical circulatory support in cases of cardiogenic shock. We report a case of spontaneous dissection of the left main stem coronary artery, with extension into the left coronary territory, which occurred in a 41-year-old lady, complicated by profound cardiogenic shock requiring recovery with extracorporeal mechanical circulatory support after salvage myocardial revascularization.

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