ABSTRACT
Spontaneous coronary artery dissection (SCAD) is a poorly understood and under-diagnosed entity of acute coronary syndrome, affecting predominantly young women. Relatively large series have been published in the past five years highlighting this condition, once believed to be rare. Indeed, the pathophysiology, natural history, clinical presentation, patient profile, diagnostic modalities, management and outcomes of SCAD are becoming better understood. The aim of our review is to provide a brief "state of the art" of SCAD in 2016 to help the clinician in the management of this challenging condition.
Subject(s)
Acute Coronary Syndrome/diagnosis , Aortic Dissection/diagnosis , Coronary Aneurysm/diagnosis , Adult , Age Factors , Diagnosis, Differential , Female , Hematoma/diagnosis , Humans , Male , Sex Factors , Tomography, Optical Coherence , Treatment OutcomeABSTRACT
Spontaneous coronary artery dissection (SCAD) is a poorly understood and under-diagnosed entity of acute coronary syndrome, affecting predominantly young women. On coronary angiography, the diagnosis remains challenging, particularly in case of intramural hematoma without intimal rupture. Intracoronary imaging, especially by optical coherence tomography (OCT), provides an incremental value in terms of diagnosis and management. We report the case of a 49-year-old woman admitted for STEMI caused by an intramural hematoma. In the discussion part, we aim to review the epidemiology, physiopathology, diagnosis, management and long-term prognosis of SCAD.
Subject(s)
Coronary Vessel Anomalies/diagnosis , Hematoma/diagnosis , Myocardial Infarction/diagnosis , Tomography, Optical Coherence , Vascular Diseases/congenital , Adrenergic beta-Antagonists/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Anticoagulants/therapeutic use , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/drug therapy , Drug Therapy, Combination , Female , Heart Conduction System/physiopathology , Hematoma/drug therapy , Hematoma/etiology , Humans , Middle Aged , Myocardial Infarction/drug therapy , Myocardial Infarction/etiology , Myocardial Infarction/physiopathology , Prognosis , Risk Factors , Smoking/adverse effects , Tomography, Optical Coherence/methods , Treatment Outcome , Vascular Diseases/complications , Vascular Diseases/diagnosis , Vascular Diseases/drug therapyABSTRACT
Pseudo-aneurysm of the fibrous continuity zone between the aortic and mitral valves, the so-called "mitral-aortic intervalvular fibrosa" is a rare complication of acute infective endocarditis, rarely after an aortic valve replacement. We report the case of a large pseudo-aneurysm occurred in a 70-year-old man, who had a history of surgical aortic valve replacement 3 years before. There were no biological or clinical evidence for infective acute endocarditis. The originality of this observation can be summarized in three points: the late onset after surgery, the absence of any infectious context and the chronic nature of pseudo-aneurysm, without any complication during a follow-up of 12 months. Transesophageal echocardiography remains the best diagnostic tool.
