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A Complex Case of Pregnancy-related Left Main Stem Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a less common cause of acute coronary syndrome. Pregnancy-related SCAD is uncommon, but often presents with a more severe phenotype. This report describes a 30-year-old woman with an anterior ST elevation MI, presenting 1 day postpartum. Left main ste...

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Autores principales: Mailey, Jonathan A, Thompson, Patrick, Johnston, Paul W, Owens, Colum G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Radcliffe Cardiology 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9306263/
https://www.ncbi.nlm.nih.gov/pubmed/35891630
http://dx.doi.org/10.15420/icr.2021.33
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author Mailey, Jonathan A
Thompson, Patrick
Johnston, Paul W
Owens, Colum G
author_facet Mailey, Jonathan A
Thompson, Patrick
Johnston, Paul W
Owens, Colum G
author_sort Mailey, Jonathan A
collection PubMed
description Spontaneous coronary artery dissection (SCAD) is a less common cause of acute coronary syndrome. Pregnancy-related SCAD is uncommon, but often presents with a more severe phenotype. This report describes a 30-year-old woman with an anterior ST elevation MI, presenting 1 day postpartum. Left main stem (LMS) SCAD with extensive intramural haematoma (IMH) and resultant LMS occlusion was confirmed by angiography and intravascular imaging. Given the extent of disease, the patient underwent emergency cardiac surgery. Coronary flow was initially improved by decompressing the IMH using cutting balloons. The coronary wires were successfully left in situ during transfer in an effort to both maintain flow and allow the surgeon to identify true LMS. Ideally, SCAD can be managed conservatively given the risk of intervention worsening IMH, and hence myocardial ischaemia/MI. However, emergency revascularisation is indicated in cases of persistent ischaemia. This case demonstrates percutaneous therapies to bridge towards and help with subsequent surgical revascularisation.
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spelling pubmed-93062632022-07-25 A Complex Case of Pregnancy-related Left Main Stem Spontaneous Coronary Artery Dissection Mailey, Jonathan A Thompson, Patrick Johnston, Paul W Owens, Colum G Interv Cardiol Coronary Spontaneous coronary artery dissection (SCAD) is a less common cause of acute coronary syndrome. Pregnancy-related SCAD is uncommon, but often presents with a more severe phenotype. This report describes a 30-year-old woman with an anterior ST elevation MI, presenting 1 day postpartum. Left main stem (LMS) SCAD with extensive intramural haematoma (IMH) and resultant LMS occlusion was confirmed by angiography and intravascular imaging. Given the extent of disease, the patient underwent emergency cardiac surgery. Coronary flow was initially improved by decompressing the IMH using cutting balloons. The coronary wires were successfully left in situ during transfer in an effort to both maintain flow and allow the surgeon to identify true LMS. Ideally, SCAD can be managed conservatively given the risk of intervention worsening IMH, and hence myocardial ischaemia/MI. However, emergency revascularisation is indicated in cases of persistent ischaemia. This case demonstrates percutaneous therapies to bridge towards and help with subsequent surgical revascularisation. Radcliffe Cardiology 2022-07-13 /pmc/articles/PMC9306263/ /pubmed/35891630 http://dx.doi.org/10.15420/icr.2021.33 Text en Copyright © 2022, Radcliffe Cardiology https://creativecommons.org/licenses/by-nc/4.0/This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.
spellingShingle Coronary
Mailey, Jonathan A
Thompson, Patrick
Johnston, Paul W
Owens, Colum G
A Complex Case of Pregnancy-related Left Main Stem Spontaneous Coronary Artery Dissection
title A Complex Case of Pregnancy-related Left Main Stem Spontaneous Coronary Artery Dissection
title_full A Complex Case of Pregnancy-related Left Main Stem Spontaneous Coronary Artery Dissection
title_fullStr A Complex Case of Pregnancy-related Left Main Stem Spontaneous Coronary Artery Dissection
title_full_unstemmed A Complex Case of Pregnancy-related Left Main Stem Spontaneous Coronary Artery Dissection
title_short A Complex Case of Pregnancy-related Left Main Stem Spontaneous Coronary Artery Dissection
title_sort complex case of pregnancy-related left main stem spontaneous coronary artery dissection
topic Coronary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9306263/
https://www.ncbi.nlm.nih.gov/pubmed/35891630
http://dx.doi.org/10.15420/icr.2021.33
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