Spontaneous coronary dissection in a pregnant woman

case report

Abstract

Spontaneous Coronary Artery Dissection (SCAD) is a rare condition that is often associated with pregnancy and has a high morbidity and mortality rate. Therapeutic options vary, from drug treatment, percutaneous coronary intervention, and myocardial revascularization surgery. We describe a case of a 38-year-old woman who presented with CASD in the 36th gestational week. Case Description: Patient without comorbidities, admitted to the Emergency Room with chest pain, radiating to the back and left upper limb, being diagnosed with AMI with ST elevation in the anterior wall. Coronary angiography showed dissection in the left main coronary artery and moderate left ventricular dysfunction. She developed hemodynamic instability and was taken to the surgical center, where an emergency cesarean delivery was performed, followed by a median thoracotomy for myocardial revascularization. Aortic counterpulsation device (intra-aortic balloon) was implanted before anesthetic induction. After sternotomy, she developed cardiac arrest. Once cardiopulmonary bypass (CPB) was established, myocardial revascularization was performed using only venous grafts. When trying to come off CPB, severe biventricular dysfunction was observed requiring vasoactive amines (noradrenaline and dobutamine). The patient was taken to the ICU in cardiogenic shock, where she developed progressive hemodynamic improvement. Extubated on the 6th DPO, discharged from the ICU on the 9th DPO, and discharged from the hospital on the 18th DPO. Conclusion: In the case presented, the option for surgical treatment for myocardial revascularization with emergency cesarean section was successful and made it possible to treat the spontaneous dissection of the TBI and the momentary dysfunction of the left ventricle.