DOI:10.2214/AJR.06.0783
AJR 2006; 187:W660
© American Roentgen Ray Society
Postpartum Spontaneous Coronary Artery Dissection: A Case of Pseudoaneurysm Evolution Detected on MDCT
Pascal Chabrot,
Pascal Motreff and
Louis Boyer
CHU Clermont Ferrand Clermont Ferrand, France
WEB—This is a Web exclusive article.
Keywords: cardiac imaging • MDCT
Spontaneous coronary dissection predominantly affecting young women is rare
but is often dramatic. A third of the cases occur at the end of pregnancy or
during the postpartum period
[1]. Its treatment remains
empiric [2], usually depending
on the symptoms, hemodynamic state, and angiography results.
A 31-year-old woman, gravida 2, para 2, without medical history of
cardiovascular disease or cardiovascular risk factors presented with an acute
myocardial infarction 3 days postpartum.
The angiography images obtained in the emergency department showed a left
main artery dissection extending to the proximal left anterior descending
(LAD) coronary artery with good distal flow and occlusion of the first
diagonal artery. Once the patient received medical treatment, the initial
clinical and ECG evolution were favorable. The next day, MDCT showed the same
dissection with recanalization of the diagonal artery
(Fig. 1A). The diagnosis was
confirmed on angiography.
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Fig. 1A —31-year-old woman, gravida 2, para 2, without medical history
of cardiovascular disease or cardiovascular risk factors who presented with
acute myocardial infarction 3 days postpartum. Initial MDCT image shows
intimal flap (arrowhead) in distal part of left main artery.
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At 6 weeks, MDCT showed a pseudoaneurysm of the left main artery in
addition to the LAD artery dissection (Figs.
1B and
1C). Because of this fast
evolution, we chose to treat the lesion with stenting guided by the MDCT
images and measurements. After angiographic confirmation, the proximal LAD and
left main arteries were treated using two short paclitaxel-eluting stents (3.5
x 8 and 4 x 8 mm; Taxus Express, Boston Scientific) to allow
intimal flap correction and closure of the pseudoaneurysm.
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Fig. 1B —31-year-old woman, gravida 2, para 2, without medical history
of cardiovascular disease or cardiovascular risk factors who presented with
acute myocardial infarction 3 days postpartum. MDCT (B) and selective
injection angiography (C) images obtained 6 weeks after presentation
show aneurysmal dilation of false lumen (arrowhead) in left main
artery dissection.
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Fig. 1C —31-year-old woman, gravida 2, para 2, without medical history
of cardiovascular disease or cardiovascular risk factors who presented with
acute myocardial infarction 3 days postpartum. MDCT (B) and selective
injection angiography (C) images obtained 6 weeks after presentation
show aneurysmal dilation of false lumen (arrowhead) in left main
artery dissection.
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The stent placement showed satisfactory exclusion of the pseudoaneurysm,
which was confirmed at 6 months using angiography and MDCT
(Fig. 1D). At 1 year after
stent placement, the patient remains asymptomatic. To our knowledge, this is
the first observation of pseudoaneurysm complicating a spontaneous coronary
dissection in which MDCT allowed an early diagnosis and was used to guide the
therapeutic strategy.
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Fig. 1D —31-year-old woman, gravida 2, para 2, without medical history
of cardiovascular disease or cardiovascular risk factors who presented with
acute myocardial infarction 3 days postpartum. MDCT image obtained 6 months
after stenting shows patent stents in distal left main and proximal left
anterior descending arteries.
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References
- Koul AK, Hollander G, Moskovits N, Frankel R. Coronary artery
dissection during pregnancy and the postpartum period: two case reports and
review of literature. Cathet Cardiovasc Intervent2001; 52:88
-94[CrossRef][Medline]
- Gowda RM, Sacchi TJ, Khan IA. Clinical perspectives of the primary
spontaneous coronary artery dissection. Int J Cardiol2005; 105:334
-336[CrossRef][Medline]
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