Recurrent post-partum coronary artery dissection

Taufiek K. Rajab, Zain I Khalpey, Bernhard Kraemer, Frederic S. Resnic, Robert P. Gallegos

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD) dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA) dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view.

Original languageEnglish (US)
Article number78
JournalJournal of Cardiothoracic Surgery
Volume5
Issue number1
DOIs
StatePublished - Oct 9 2010
Externally publishedYes

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Dissection
Coronary Vessels
Myocardial Infarction
Stents
Electric Countershock
Ventricular Fibrillation
Cardiac Catheterization
Catheterization
Stroke Volume
Echocardiography
Anatomy
Angiography
Perfusion
Mortality
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Recurrent post-partum coronary artery dissection. / Rajab, Taufiek K.; Khalpey, Zain I; Kraemer, Bernhard; Resnic, Frederic S.; Gallegos, Robert P.

In: Journal of Cardiothoracic Surgery, Vol. 5, No. 1, 78, 09.10.2010.

Research output: Contribution to journalArticle

Rajab, Taufiek K. ; Khalpey, Zain I ; Kraemer, Bernhard ; Resnic, Frederic S. ; Gallegos, Robert P. / Recurrent post-partum coronary artery dissection. In: Journal of Cardiothoracic Surgery. 2010 ; Vol. 5, No. 1.
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