Surgical management of spontaneous left main coronary artery dissection

Thistlethwaite, Patricia A.; Tarazi, Riyad; Giordano, Frank J.; Jamieson, Stuart W.

doi:10.1016/s0003-4975(98)00382-8

Cited by 65 publications

(47 citation statements)

References 4 publications

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“…[5] Surgical revascularization is preferred for SCAD with multivessel involvement, LMCA involvement, or refractory recurrent ischemia. [5,6] We think that even when the dissection is on a single vessel, surgical revascularization has to be kept in mind according to the extent, type, and severity of the dissection. Thus, we decided to perform CABG with an endarterectomy, although only the LAD was involved in the first case, because of the long, spiralshaped dissection.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection: two different surgical techniques

Yılmazkaya¹

2011

Turkish J Thorac Cardiovasc Surg

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Bu yazıda iki spontan koroner arter diseksiyonu olgusunda uygulanan iki farklı cerrahi teknik tartışıldı. Birinci olguda sol anterior inen artere (LAD) endarterektomi sonrası sol internal torasik arter anastomozu (LİTA) yapılır iken, ikinci olguda diseke LAD katmanları tamir edildi ve LİTA anastomozu gerçekleştirildi. Predispozan faktörler varlığında veya bypass ya da anjiyoplastiye uygun olmayan damarlarda endarterektomi yapılmasını önermekteyiz.Anah tar söz cük ler: Koroner anevrizma; endarterektomi; spontan koroner arter diseksiyonu.In this article, two different surgical techniques employed in two cases of spontaneous coronary artery dissection are discussed. In the first case, left internal thoracic artery anastomosis (LITA) to left anterior descending artery (LAD) after endarterectomy was performed and in the second case, the dissected LAD layers were repaired and LITA anastomosis was performed. We recommend the use of endarterectomy in the presence of predisposing factors and in vessels inappropriate for bypass or angioplasty.Key words: Coronary aneurysm; endarterectomy; spontaneous coronary artery dissection. Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial ischemia or sudden death, [1] and it results from an intramural hematoma in the media of the arterial wall that creates a false lumen.[2] The intramural hematoma in the false lumen causes compression and/or occlusion of the true lumen which leads to myocardial ischemia.[3] This article presents two cases of SCAD in which two different surgical techniques were used according to the type of dissection presented. CASE REPORTCase 1-A 37-year-old female was admitted to another cardiology clinic with chest pain. Coronary angiography was performed due to ST segment and T wave changes at the anterior and lateral leads on an electrocardiogram (ECG) which were associated with ischemia. A long segment of spiral dissection of the left anterior descending artery (LAD) was defined (Figure 1). The patient was hemodynamically stable at the time of admission to our hospital. She did not have any history of prior pregnancies or abortions. The only risk factors for SCAD were oral contraceptive use and a history of smoking. Normal serum and urine b human chorionic gonadotropin (HCG) tests excluded pregnancy. Urgent coronary artery bypass grafting (CABG) was planned for the dissected artery. Surgical CABG was performed with cardiopulmonary bypass (CPB), moderate hypothermia (29 ºC), and antegrade and retrograde cardioplegia under general anesthesia conditions. The spiral dissection on the LAD was long, beginning from the first diagonal branch and continuing towards the distal site of the vessel. There were thrombi as well as ecchymosis between the medial and adventitial layers. The thrombotic areas were excised and a 10 cm endarterectomy was performed on the LAD. The left internal thoracic artery (LITA) was cut longitudinally, and a 10 cm patch angioplasty was performed on the LAD (Figure 2). On the sixth postoperative day, a coronary angi...

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Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection: two different surgical techniques

Yılmazkaya¹

2011

Turkish J Thorac Cardiovasc Surg

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“…15 In patients with ongoing myocardial ischaemia or in patients refractory to medical treatment, bypass surgery also is the most appropriate therapy.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection in the postpartum period

Branden¹,

Bruggeling²,

Dunselman³

2008

NHJL

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“…[29][30][31][32][33] Surgical revascularization via CABG remains the optimal therapy in patients whose dissection involves the LMCA, in patients with concurrent multivessel dissection, and in patients with disease refractory to medical management. 3,8,14,34 Selected left main dissections may ultimately prove amenable to PCI as overall experience accrues with left main stenting.…”

Section: Discussionmentioning

confidence: 99%

Postpartum dissection of the left main coronary artery

Rogers

Rinaldi

Humphrey

et al. 2006

Clinical Cardiology

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Summary: Peripartum coronary artery dissection is rare, but it is an increasingly recognized risk to women of childbearing age. Literature reviews reveal that about 80% of the population with spontaneous coronary artery dissections (SCAD) are female, and approximately 25-33% of cases occurred while the woman was pregnant or in the peripartum phase. Most cases have presented within 2 weeks of delivery. The left anterior descending is the most commonly affected vessel. The etiology is poorly understood, but many reports suggest that SCAD occurs as a result of protease release secondary to an eosinophilic vasculitis resulting in vessel lysis. Many investigators have examined the correlation between peripartum SCAD and estrogen levels; however, case studies have shown conflicting results regarding estrogen levels as the putative causative factor. Optimal treatment remains controversial. Presently, stenting appears to be best employed in the patients who have singlevessel dissection not involving the left main coronary artery (LMCA). Surgical revascularization via coronary artery bypass graft remains the optimal therapy in patients whose dissection involves the LMCA, in patients with concurrent multivessel dissection, and in patients with disease refractory to medical management. It is important to consider coronary artery dissection in the differential of any young woman who presents with signs or symptoms consistent with acute coronary syndrome, particularly if she is peripartum. Furthermore, once suspected, it is imperative that a definitive diagnostic study, that is, coronary angiography, be completed prior to the initiation of treatment whenever possible.

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Surgical management of spontaneous left main coronary artery dissection

Cited by 65 publications

References 4 publications

Spontaneous coronary artery dissection: two different surgical techniques

Spontaneous coronary artery dissection: two different surgical techniques

Spontaneous coronary artery dissection in the postpartum period

Postpartum dissection of the left main coronary artery

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