scholarly journals Case Report: Cardiac arrest due to traumatic coronary artery dissection treated by extracorporeal membrane resuscitation

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1720
Author(s):  
Kumiko Tanaka ◽  
Taka-aki Nakada ◽  
Tadayuki Kadohira ◽  
Shigeto Oda
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Cardiopulmonary Resuscitation ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Circumflex Artery ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Left Circumflex Artery

Traumatic coronary artery dissection, which is rare in blunt trauma, has high risk of acute myocardial infarction and cardiac arrest. A 44-year-old man who had a traffic accident was transferred to the emergency department with refractory ventricular fibrillation (VF). After conventional cardiopulmonary resuscitation, we introduced extracorporeal cardiopulmonary resuscitation (ECPR) and obtained return of spontaneous circulation with ST-elevation electrocardiogram at V4-6. Subsequent coronary angiography and intravascular ultrasound supported by extracorporeal membrane oxygenation (ECMO) revealed complete occlusions of left anterior descending and left circumflex artery due to dissections. Drug-eluting stents were placed with restorations of TIMI 2 flows. After ICU admission, his left ventricular function gradually recovered; he was successfully weaned from VA-ECMO on day 9. ECPR may be a valuable option to allow time and stable hemodynamic condition to treat the cause of cardiac arrest.

scholarly journals Three broken vessels in a peripartum patient: a rare case report of spontaneous triple vessel coronary artery dissection

2020 ◽  
Vol 4 (5) ◽  
pp. 1-6
Author(s):  
Hassan Lak ◽  
Karim Abdul Rehman ◽  
Wael A Jaber ◽  
Leslie Cho
Keyword(s):  
Coronary Artery ◽  
Troponin I ◽  
Significant Risk ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Coronary Syndrome

Abstract Background Spontaneous coronary artery dissection (SCAD) is a frequently underdiagnosed entity that carries a significant risk of morbidity and mortality. Spontaneous coronary artery dissection is increasingly recognized as an important cause of acute coronary syndrome (ACS) and, the majority of SCAD patients are young healthy women. Case summary A 23-year-old female G5P4 presented to the emergency room for severe sub-sternal chest pain, associated with shortness of breath. Past medical history was significant for pre-eclampsia. Initial electrocardiogram was remarkable for ST depressions in V5–V6 with inverted T waves to V1–V2. Troponin I was elevated to 1.13 ng/mL. Two-dimensional echo showed reduced left ventricular function with an ejection fraction of 40%. Cardiac catheterization showed triple vessel dissection involving the left main trunk extending into mid-left anterior descending and dissection extending from ostium of left circumflex artery into large first obtuse marginal branch. She was started on aspirin and heparin. After 48 h she was loaded with clopidogrel. Computed tomography angiography of head, neck, abdomen, and pelvis showed findings compatible with fibromuscular dysplasia. She was haemodynamically stable and symptom free and did not want surgery. She was recommended to continue dual antiplatelet therapy for 12 months and subsequently aspirin and beta blocker only lifelong. Discussion Spontaneous coronary artery dissection is a rare condition which is underdiagnosed. A thorough history and high degree of suspicion is required to diagnose in a timely manner and it should be high on differential in a postpartum female presenting with signs and symptoms of ACS.

scholarly journals Effects of extracorporeal cardiopulmonary resuscitation on neurological and cardiac outcome after ischaemic refractory cardiac arrest

2017 ◽  
Vol 7 (5) ◽  
pp. 432-441 ◽  
Author(s):  
Francesca Cesana ◽  
Leonello Avalli ◽  
Laura Garatti ◽  
Anna Coppo ◽  
Stefano Righetti ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Left Ventricular Ejection Fraction ◽  
Cardiopulmonary Resuscitation ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Ventricular Ejection Fraction ◽  
Return Of Spontaneous Circulation ◽  
Refractory Cardiac Arrest

Background: Extracorporeal cardiopulmonary resuscitation is increasingly recognised as a rescue therapy for refractory cardiac arrest, nevertheless data are scanty about its effects on neurologic and cardiac outcome. The aim of this study is to compare clinical outcome in patients with cardiac arrest of ischaemic origin (i.e. critical coronary plaque during angiography) and return of spontaneous circulation during conventional cardiopulmonary resuscitation vs refractory cardiac arrest patients needing extracorporeal cardiopulmonary resuscitation. Moreover, we tried to identify predictors of survival after successful cardiopulmonary resuscitation. Methods: We enrolled 148 patients with ischaemic cardiac arrest admitted to our hospital from 2011–2015. We compared clinical characteristics, cardiac arrest features, neurological and echocardiographic data obtained after return of spontaneous circulation (within 24 h, 15 days and six months). Results: Patients in the extracorporeal cardiopulmonary resuscitation group ( n=63, 43%) were younger (59±9 vs 63±8 year-old, p=0.02) with lower incidence of atherosclerosis risk factors than those with conventional cardiopulmonary resuscitation. In the extracorporeal cardiopulmonary resuscitation group, left ventricular ejection fraction was lower than conventional cardiopulmonary resuscitation at early echocardiography (19±16% vs 37±11 p<0.01). Survivors in both groups showed similar left ventricular ejection fraction 15 days and 4–6 months after cardiac arrest (46±8% vs 49±10, 47±11% vs 45±13%, p not significant for both), despite a major extent and duration of cardiac ischaemia in extracorporeal cardiopulmonary resuscitation patients. At multivariate analysis, the total cardiac arrest time was the only independent predictor of survival. Conclusions: Extracorporeal cardiopulmonary resuscitation patients are younger and have less comorbidities than conventional cardiopulmonary resuscitation, but they have worse survival and lower early left ventricular ejection fraction. Survivors after extracorporeal cardiopulmonary resuscitation have a neurological outcome and recovery of heart function comparable to subjects with return of spontaneous circulation. Total cardiac arrest time is the only predictor of survival after cardiopulmonary resuscitation in both groups.

scholarly journals Successful Percutaneous Coronary Intervention Using Intravascular Ultrasound-Guided Rewiring Technique in a Case of Spontaneous Coronary Artery Dissection Involving Left Main Bifurcation

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Yohei Numasawa ◽  
Souichi Yokokura ◽  
Yasuhiro Hitomi ◽  
Shohei Imaeda ◽  
Makoto Tanaka ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Guide Wire ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
True Lumen ◽  
Coronary Artery Dissection ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Percutaneous Coronary ◽  
St Elevation

We herein describe a 49-year-old woman without significant cardiovascular risk factors who was transferred to our hospital with sudden onset of chest pain. The patient was diagnosed with non-ST-elevation acute myocardial infarction, and coronary angiography revealed a dissection at the proximal site of the left anterior descending artery (LAD) extending from the left main trunk (LMT) suggestive of spontaneous coronary artery dissection (SCAD). Because coronary flow was impaired after contrast injection and the patient had chest pain with ST elevation, urgent percutaneous coronary intervention was performed. The first guide wire was initially introduced from the LMT to the distal LAD, but intravascular ultrasound (IVUS) imaging revealed that the guide wire had passed through the true lumen of the left coronary artery ostium, false lumen at the ostium of the left circumflex artery, and true lumen of the distal LAD. We then reinserted another guide wire using an IVUS-guided rewiring technique from the true lumen of the LMT to the distal LAD. Finally, a drug-eluting stent was deployed to cover the dissected segment, and final coronary angiography revealed acceptable results with a patent left circumflex artery. This case report highlights that physicians should consider SCAD among the differential diagnoses in patients presenting with acute coronary syndrome, particularly in young women. In the present case, IVUS played a pivotal role in not only detecting the arterial dissection but also correctly introducing the guide wire into the true lumen.

scholarly journals Spontaneous coronary artery dissection of the proximal left circumflex artery: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Aleksandra Pineda ◽  
Josh Martin ◽  
Aniket Puri ◽  
Bijan Jahangiri
Keyword(s):  
Coronary Artery ◽  
Adverse Outcomes ◽  
Artery Dissection ◽  
Large Artery ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Coronary Syndrome ◽  
Increased Risk

Abstract Background Spontaneous coronary artery dissection (SCAD) has gained attention as an important cause of acute coronary syndrome and sudden cardiac death (SCD) among women. Management strategies of SCAD differ from those of atherosclerotic disease. There is an elevated risk of complications and suboptimal outcomes in patients with SCAD undergoing percutaneous coronary interventions (PCIs). Case summary A 48-year-old woman without any traditional cardiovascular risk factors was admitted with severe central chest pain with associated dyspnoea and diaphoresis. The patient had a strong family history of SCD, affecting three female members in their 40s and 50s. Cardiac troponins were elevated. Coronary angiogram showed moderate to severe stenosis of the proximal circumflex coronary artery. Optical coherence tomography confirmed SCAD with sub-intimal haematoma. Despite significant stenosis in the proximal segment of a relatively large artery, a decision was made not to proceed with PCI. The follow-up angiogram demonstrated normal coronaries. Magnetic resonance imaging of renal arteries showed features suggestive of fibromuscular dysplasia affecting the right renal artery. Subsequent genetic counselling and gene testing were unremarkable. Discussion Conservative management of SCAD is recommended because the large majority of SCAD lesions heal naturally, whereas PCI is associated with increased risk of complications and adverse outcomes. Whether SCAD is associated with the sudden death events in our patient’s family remains unclear. It certainly raises concerns as to an inheritable condition. In the absence of post-mortem findings in her family members, we can only speculate about this representing a possible inheritable form of SCAD.

scholarly journals Left anterior descending coronary artery dissection during ventricular tachycardia ablation – case report

2018 ◽  
Vol 56 (1) ◽  
pp. 63-66
Author(s):  
Kresimir Kordic ◽  
Sime Manola ◽  
Ivan Zeljkovic ◽  
Ivica Benko ◽  
Nikola Pavlovic
Keyword(s):  
Ventricular Tachycardia ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Complication Rates ◽  
Left Main ◽  
Coronary Artery Dissection ◽  
Ventricular Tachycardia Ablation ◽  
First Case

Abstract Fascicular left ventricular tachycardia (VT) is the second most frequent idiopathic left VT in the setting of a structurally normal heart. Catheter ablation is curative in most patients with low complication rates. We report a case of ostial left anterior descending coronary artery (LAD) occlusion during fascicular ventricular tachycardia ablation. Dissection was the most likely cause of LAD obstruction. To the authors’ best knowledge, this is the first case reporting selective LAD dissection during electrophysiology study with no left main coronary artery (LMCA) affection.

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