Spontaneous left anterior descending coronary artery dissection requiring coronary artery bypass surgery
Rev. bras. cir. cardiovasc
; 32(6): 536-538, Nov.-Dec. 2017. tab, graf
Article
in English
| LILACS
| ID: biblio-897965
Responsible library:
BR1.1
ABSTRACT
Abstract Introduction:
Spontaneous coronary artery dissection is a sudden separation between the layers of a coronary artery wall, non-iatrogenic or trauma related, that has been recognized as an important cause of myocardial infarction.Objective:
To report an emblematic case, in terms of angiographic images, clinical presentation and predisposing factors, whose clinical management failure led to surgical intervention.Methods:
A previously healthy 48-year-old male farmer was admitted to the emergency room complaining of anterior chest pain described as "tearing", which started after physical exertion. Anterior wall ST-segment depression was observed in the electrocardiogram and troponin levels were increased. The patient then underwent coronary catheterization. Angiography showed a tortuous left anterior descending coronary artery with a dissection line involving proximal and middle segments, resulting in mild to moderate luminal stenosis. At first, a conservative approach was chosen. Control cardiac catheterization, 3 months later, showed dissection progression to the distal segment.Results:
The patient was referred to surgical treatment. Internal thoracic artery and a great saphenous vein graft were used to revascularize the target vessels. He had an uneventful postoperative course.Conclusion:
In this report, we describe a typical clinical manifestation of an uncommon cause of acute myocardial infarction. The dissection was started by an extreme physical effort, which is a known triggering factor. Management of these cases is always challenging because there are no evidence-based therapies or guideline-based recomendations.
Full text:
Available
Collection:
International databases
Database:
LILACS
Main subject:
Vascular Diseases
/
Coronary Artery Bypass
/
Coronary Vessel Anomalies
Type of study:
Etiology study
/
Practice guideline
Limits:
Humans
/
Male
Language:
English
Journal:
Rev. bras. cir. cardiovasc
Journal subject:
Cardiology
/
CIRURGIA GERAL
Year:
2017
Document type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Universidade Federal do Rio Grande do Sul (HCPA-UFRGS)/BR