血管医学および外科ジャーナル

概要

Spontaneous Multivessel Dissection in Young Woman - What is the Best Treatment Strategy?

Trendafilova D, Jorgova J and Nachev G

This report describes the case of a 44 year-old female who was referred to our hospital after cardiac arrest and successful resuscitation. Coronary angiography revealed spontaneous dissection in a large segment of LM to LAD. The patient was referred to emergent coronary artery by-pass surgery. Four years later she was admitted with clinical and ECG findings for STEMI. Coronary angiography showed patent left coronary arteries, occluded venous graft to Rcx, occluded LIMA-LAD and spontaneous proximal dissection and occlusive thrombus in RCA. The vessel was successfully re-canalized and stented. Two years later the patient was admitted for coronary angio with symptoms of progressive heart failure. The diagnostic angio showed patent coronary arteries, occluded grafts and left ventricle aneurysm with EF 38% and severe MR. After discussion with the surgeons she received a mitral valve reconstruction. There are no specific guidelines how to manage these patients. For cases of multivessel disease and particularly when the left main or LADis affected, cardiac surgery/or PCI/ may be the therapy of choice. There are reported cases where treatment of LM dissection has been conducted successfully and conservatively.