Spontaneous Coronary Artery Dissection Post Partum

J INVASIVE CARDIOL 2021;33(4):E316. 

Key words: coronary artery dissection, subintimal hematoma

A previously healthy 30-year-old woman presented with extensive anterior myocardial infarction at day 6 post partum. Coronary angiogram showed proximal left anterior descending (LAD) coronary artery dissection with an intimal flap starting at the ostial segment and extending to the mid segment separating a large false lumen from a narrow true lumen (Figure 1A; Video 1). Percutaneous coronary intervention was successfully performed using a 3.5 x 38 mm Resolute Integrity drug-eluting stent (Medtronic) with good angiographic result and Thrombolysis in Myocardial Infarction 3 flow (Figure 1B; Video 2). Optical coherence tomography of the LAD showed a widely patent vessel with a crescent hypointense image spanning the stent struts, suggesting a subintimal hematoma (Figure 1C). At 1 year follow-up, the patient was asymptomatic and multidetector cardiac computed tomography showed patency of the LAD stent with no residual wall hematoma.

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From the ¹Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; ²Department of Interventional Cardiology, University Hospital of Caen, Caen, France; and ³Faculty of Medicine, LAU Medical Center, Rizk Hospital, Lebanon.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted April 21, 2020.

Address for correspondence: Ziad Dahdouh, MD, Heart Center, King Faisal Specialist Hospital & Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh 12713, Saudi Arabia. Email: ziad_dahdouh@hotmail.com