RESUMO
Coronary artery dissection is a rare cause of acute coronary syndrome. Most cases occur in women during the peripartum period, most likely influenced by hormonal changes, hemodynamic stress and modifications in the immune system during pregnancy. The pathogenesis of coronary artery dissection is unknown, hence numerous theories have been postulated such as pregnancy-related conditions, the presence of connective tissue disorders, trauma, etc. The clinical presentation ranges from asymptomatic patients to the whole spectrum of acute coronary syndrome manifestations. The management of these patients requires a multidisciplinary approach, with two options: medical therapy or an invasive approach, with percutaneous coronary intervention or coronary artery bypass graft surgery. The choice of treatment options depends on the hemodynamic status of the patient, the extension of the dissection and the myocardial territory at risk. In this case report we present a 38-year-old female who had a coronary artery dissection seven days postpartum. Coronary catheterization showed dissection of the left main coronary artery that extended until the circumflex artery. An intra-aortic balloon pump was installed and the patient then underwent coronary artery bypass graft surgery, with satisfactory results.
Assuntos
Anomalias dos Vasos Coronários/cirurgia , Doenças Vasculares/congênito , Angioplastia Coronária com Balão , Anomalias dos Vasos Coronários/diagnóstico , Feminino , Humanos , Período Pós-Parto , Gravidez , Doenças Vasculares/diagnóstico , Doenças Vasculares/cirurgiaRESUMO
Coronary artery dissection is a rare cause of acute coronary syndrome. Most cases occur in women during the peripartum period, most likely influenced by hormonal changes, hemodynamic stress and modifications in the immune system during pregnancy. The pathogenesis of coronary artery dissection is unknown, hence numerous theories have been postulated such as pregnancy-related conditions, the presence of connective tissue disorders, trauma, etc. The clinical presentation ranges from asymptomatic patients to the whole spectrum of acute coronary syndrome manifestations. The management of these patients requires a multidisciplinary approach, with two options: medical therapy or an invasive approach, with percutaneous coronary intervention or coronary artery bypass graft surgery. The choice of treatment options depends on the hemodynamic status of the patient, the extension of the dissection and the myocardial territory at risk. In this case report we present a 38-year-old female who had a coronary artery dissection seven days postpartum. Coronary catheterization showed dissection of the left main coronary artery that extended until the circumflex artery. An intra-aortic balloon pump was installed and the patient then underwent coronary artery bypass graft surgery, with satisfactory results.
