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Postpartum Spontaneous Coronary Artery Dissection Recovered by Coronary Artery Bypass Grafting Supported With Impella Device
J INVASIVE CARDIOL 2023;37(7):E75-E83
Key words: Impella, optical coherence tomography, postpartum spontaneous coronary artery dissection
A 34-year-old female who had delivered a baby 9 days ago was transferred to our hospital due to sudden dyspnea and cardiogenic shock. Her electrocardiogram showed ST-segment elevation in precordial leads, and left ventricular ejection fraction was 20%. Emergent coronary angiogram showed severe stenosis in the proximal of left anterior descending artery (LAD) with dissection (Figure 1).
Figure a-d. Optical coherence tomography (OCT) images, a. No coronary artery dissection was found at the distal of LAD, b, c. OCT revealed coronary artery dissection corresponding to the CAG findings, d. Entry of the coronary artery dissection.
Optical coherence tomography revealed coronary artery dissection from the middle of the LAD to the left main trunk (Figure a-d). Although intra-aortic balloon pumping (IABP) was inserted, her hemodynamic status was not improved. Therefore, we decided to change the IABP to the Impella device, and she underwent emergent coronary artery bypass grafting (CABG). She broke away from the Impella on postoperative day 7. She was discharged home on hospital day 38 in stable condition.
Spontaneous coronary artery dissection (SCAD) is one of the important causes of acute coronary syndrome (ACS) and has accounted for 1~4% of ACS. SCAD during or shortly following pregnancy (P-SCAD) have a more severe clinical presentation than that is not associated with pregnancy, because patients with P-SCAD were more likely to have SCAD in the left main trunk or multi-vessels and hemodynamic instability. Conservative therapy should be selected if the patients are clinically stable. However, revascularization is required for patients with proximal or multivessel SCAD, unstable hemodynamics, or occlusion after initial conservative management. This is the first presentation for a postpartum SCAD recovered by CABG under supporting with the Impella device.
Affiliations and Disclosures
From 1Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan, 2Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan.
Disclosure: The authors report no financial relationships or conflicts of interest regarding the content herein.
Acknowledgement: We thank Toshiki Nishioeda and Kentaro Honda for supporting this case.
Manuscript accepted January 18, 2023.
Address for correspondence: Yuichi Ozaki, MD, PhD, Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan, Email: you1mail0412@gmail.com.
