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Eur J Cardiothorac Surg 2005;28:349-351
© 2005 Elsevier Science NL

Case report

Spontaneous coronary artery dissection in a young woman: from emergency coronary artery bypass grafting to heart transplantation

Department of Cardiovascular Surgery, Centre Hôpitalier Universitaire Vaudois (CHUV), 46 Rue du Bugnon, CH-1011 Lausanne, Switzerland

Received 7 April 2005; accepted 21 April 2005.

^* Corresponding author. Tel.: +41 79 310 1386; fax: +41 21 314 2278. (Email: enrico.ferrari{at}hospvd.ch).

Primary spontaneous coronary artery dissection (SCAD) as cause of acute myocardial infarction is a rare entity with complex pathophysiology. SCAD must be considered every time that a healthy young patient presents an onset of acute myocardial ischemic syndrome or sudden death. Mostly it appears in young women without traditional risk factors for coronary artery disease and a significant proportion of them are hutted during the peripartum or early postpartum period. SCAD is frequently fatal and a great number of known cases have been diagnosed at necroscopy. The quick recognition of SCAD as cause of acute myocardial ischemia in a young patient is important to establish the best medical/surgical treatment between the different therapeutic attitudes. We describe the case occurred to a young low cardiac risk woman who suffered of idiopathic SCAD and was successfully treated by heart transplantation few days after that a conventional surgical myocardial revascularization had been attempted. Waiting for cardiac transplantation the patient survived several days, thanks to a mechanical left ventricular assist device (LVAD). The following hospital course was uncomplicated. To our knowledge, this is the second case of SCAD treated successfully by LVAD and orthotopic heart transplantation reported in literature.

Key Words: Spontaneous coronary artery dissection (SCAD) • Coronary artery bypass grafting (CABG) • Heart transplantation • Ventricular assist device

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