Primary Spontaneous Coronary Artery Dissection Research Articles

Primary spontaneous coronary dissectİon in a young male and the role of intravascular ultrasonography for diagnosis and treatment

Primary spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and is observed especially during gestation or the postpartum period of young healthy female patients. SCAD is much more rarely seen in young male patients. A 32year-old male was admitted to our clinic with a typical anginal complaint that had begun after a verbal discussion in a family environment. The patient was hospitalized with a diagnosis of acute myocardial infarction without ST elevation. During coronary angiography, a lesion seen as a dissection in the proximal region of the left anterior descending artery (LAD), 30% stenosis in the circumflex artery and plaque in the right coronary artery were observed. In the LAD osteal region, a dissection flap and intimal rupture was observed at the 12:00–2:00 o'clock position using intravascular ultrasonography (IVUS). Our case was very young and had no atherosclerotic risk factors except for a history of smoking. It was suggested that intense emotional stress was the triggering factor for coronary dissection. The gold standard imaging method for spontaneous coronary dissection is coronary angiography. Recently, imaging methods like IVUS have made important contributions to the diagnosis of dissections that cannot be detected by coronary angiography. Treatment must be individual since there is no standard protocol. Medical therapy, percutaneous coronary intervention and coronary artery bypass surgery are the main treatment options.

PP-181 CORONARY BYPASS GRAFTING IN A YOUNG PATIENT WITH CORONARY DISSECTION ASSOCIATED ACUTE CORONARY SYNDROME

PP-181 CORONARY BYPASS GRAFTING IN A YOUNG PATIENT WITH CORONARY DISSECTION ASSOCIATED ACUTE CORONARY SYNDROME F.G. Yesil, M. Tavlasoglu, M. Kurkluoglu, Z. Arslan, A. Guler, M.A. Sahin, F. Cingoz. Department of Cardiovascular Surgery, Gulhane Military Medical Hospital, Etlik, Ankara, Turkey; Department of Cardiovascular Surgery, Diyarbakir Military Medical Hospital, Yenisehir, Diyarbakir, Turkey; Department of Cardiovascular Surgery, Children’s National Heart Institute, Children’s National Medical Center, Washington, DC, USA; Gelibolu Military Hospital, Department of Cardiology, Canakkale, Turkey Background: Primary spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) with an estimated prevalence of 0.1–1.1% in angiographic series and especially seen in younger females. Methods: A young patient aged 38 year applied the emergency service with a diagnosis of acute coronary syndrome. In angiographic screening, three vessels disease including LAD artery lesion was diagnosed. An urgent operation was decided.

PP-182 ACUTE MYOCARDIAL INFARCTION CAUSED BY GIANT RIGHT CORONARY ARTERY ANEURYSM

PP-181 CORONARY BYPASS GRAFTING IN A YOUNG PATIENT WITH CORONARY DISSECTION ASSOCIATED ACUTE CORONARY SYNDROME F.G. Yesil, M. Tavlasoglu, M. Kurkluoglu, Z. Arslan, A. Guler, M.A. Sahin, F. Cingoz. Department of Cardiovascular Surgery, Gulhane Military Medical Hospital, Etlik, Ankara, Turkey; Department of Cardiovascular Surgery, Diyarbakir Military Medical Hospital, Yenisehir, Diyarbakir, Turkey; Department of Cardiovascular Surgery, Children’s National Heart Institute, Children’s National Medical Center, Washington, DC, USA; Gelibolu Military Hospital, Department of Cardiology, Canakkale, Turkey Background: Primary spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) with an estimated prevalence of 0.1–1.1% in angiographic series and especially seen in younger females. Methods: A young patient aged 38 year applied the emergency service with a diagnosis of acute coronary syndrome. In angiographic screening, three vessels disease including LAD artery lesion was diagnosed. An urgent operation was decided.

Spontaneous Coronary Artery Dissections: Three Case Reports and Review of Literature

Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction and is mostly fatal. Previous studies report that it is mostly seen in middle-aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern, and its severity is related to extent and development rate of dissection. Herein we present three cases of primary spontaneous left main coronary artery dissection. Two of the patients are men and the third patient is a non-pregnant 69-year-old woman. The cases were presented and discussed with review of the pertinent literature.

ECMO as a bridge to transplantation in biventricular dysfunction due to primary spontaneous coronary artery dissection

ECMO as a bridge to transplantation in biventricular dysfunction due to primary spontaneous coronary artery dissection

Primary spontaneous coronary artery dissection complicated by iatrogenous aortic dissection: from David procedure to full arterial coronary revascularization

Primary spontaneous coronary artery dissection (PSCAD) is an uncommon cause of acute myocardial infarction that can lead to fatal course especially because of non-standardized management. We report the case of a 37-year-old woman who presented with a PSCAD of the right coronary artery. A young woman was addressed to our hospital for a PSCAD of the right coronary artery (RCA). During the coronary angiogram, an iatrogenous type II aortic dissection occurred. She was then scheduled for surgery since ascending aortic diameter after the dissection was measured at 52 mm. A David procedure was made to replace the aortic root. Since weaning from cardiopulmonary bypass (CPB) was easy without ischemic signs in the right territory, we didn't systematically graft the RCA. Thirty minutes after the end of the procedure, a cardiogenic shock occurred witnessing a complete thrombosis of the RCA. CPB was restarted and the RCA was grafted on-pump using a right internal thoracic artery (RITA). The left network was examined and also showed to be dissected. Using the LITA, a T-graft was constructed and the left anterior descending and a marginal branch were grafted, rendering the weaning from CPB possible. Postoperative troponin at day 1 was 93 microg/l. Weaning from inotropic drugs and from intra-aortic balloon pump was possible after four days. Extubation was postponed because of a pulmonary infection due to hemophilus influenzae. It was done at day 14. Echographic control showed no residual aortic insufficiency. CT-scan showed a patent RITA-to-RCA graft but an involution of the LITA graft, along with a healing of the left network. PSCAD is a severe condition and its management is unclear. The grafting of the diseased coronaries can be facilitated by an on-pump technique and the use of a coronary shunt to avoid further ischemia.

Spontaneous coronary artery dissection in a young woman: from emergency coronary artery bypass grafting to heart transplantation

Primary spontaneous coronary artery dissection (SCAD) as cause of acute myocardial infarction is a rare entity with complex pathophysiology. SCAD must be considered every time that a healthy young patient presents an onset of acute myocardial ischemic syndrome or sudden death. Mostly it appears in young women without traditional risk factors for coronary artery disease and a significant proportion of them are hutted during the peripartum or early postpartum period. SCAD is frequently fatal and a great number of known cases have been diagnosed at necroscopy. The quick recognition of SCAD as cause of acute myocardial ischemia in a young patient is important to establish the best medical/surgical treatment between the different therapeutic attitudes. We describe the case occurred to a young low cardiac risk woman who suffered of idiopathic SCAD and was successfully treated by heart transplantation few days after that a conventional surgical myocardial revascularization had been attempted. Waiting for cardiac transplantation the patient survived several days, thanks to a mechanical left ventricular assist device (LVAD). The following hospital course was uncomplicated. To our knowledge, this is the second case of SCAD treated successfully by LVAD and orthotopic heart transplantation reported in literature.

Clinical perspectives of the primary spontaneous coronary artery dissection

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome or sudden death. Typically it affects young women during the peripartum period and those using oral contraceptives. The pathophysiology remains unclear, but an eosinophilic periadventitial inflammation has been commonly observed in such cases. Unlike atherosclerotic intimal dissection, the dissection plane in the spontaneous dissection lies within the media or between the media and adventitia. Due to the rarity of the condition, the optimal management of the spontaneous coronary artery dissection has not been established and it may range from conservative medical treatment to percutaneous or surgical interventions depending upon the anatomy of the dissection, compromise of the vessel lumen and the clinical circumstances. The reported prognosis varies widely. Spontaneous coronary artery dissection should be considered in the differential diagnosis in young persons with precordial chest pain, especially women in the peripartum state and those using oral contraceptives. The clinical perspectives of the primary spontaneous coronary artery dissection are elaborated.

Primary spontaneous coronary artery dissections in atherosclerotic patients. Report of nine cases with review of the pertinent literature.

Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction. Previous studies reports that it is mostly seen in middle aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern and severity related to extent and development rate of dissection. In the last 2 years, nine non-pregnant primary spontaneous coronary artery dissection cases were found in coronary angiography among 3750 patients prediagnosed as coronary artery disease. The cases were presented and discussed with review of the pertinent literature.

Spontaneous Coronary Artery Dissection: Case Report and Literature Review

Primary coronary artery dissection occurring 2 months post partum in a 33-year-old woman is described. Owing to suspected acute myocardial infarction, the patient was treated with thrombolytic therapy but her condition deteriorated. Coronary angiography showed dissection of the left anterior descending artery (LAD). Her condition stabilized during treatment with intravenous heparin, aspirin, nitrates, beta-blockers, digoxin, ACE inhibitor and anticoagulants. At discharge she had no symptoms of heart failure. One hundred and forty one cases from the literature are reviewed with special reference to patient characteristics, patient treatment, and prognosis. Primary spontaneous coronary artery dissection is a rare condition but one that must be considered when young people, especially post partum women, present an acute ischaemic syndrome. Thrombolytic therapy may be a two-edged sword and therefore early angiography should be considered in making the diagnosis and choosing the therapy.