CASE REPORTS   

Minerva Cardioangiologica 2013 February;61(1):89-98

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Acute myocardial infarction caused by multivessel spontaneous coronary artery dissection in a postpartum woman

Vecchio S., Varani E., Balducelli M., Aquilina M., Vecchi G., Margheri M. ✉

Division of Cardiology, Cardiac Catheterization Laboratory, Santa Maria delle Croci Hospital, Ravenna, Italy

Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women not experiencing traditional risk factors for coronary artery disease during pregnancy or postpartum period. The pathophysiology of spontaneous arterial dissection remains uncertain and the management may be challenging. Herein, we report a case of a 41-year woman with no apparent cardiovascular risk factors, who underwent a successfull in vitro fertilization and embryo transfer with a subsequent at term cesarean section of a twin pregnancy. Six days after delivery, she presented with anterior ST-segment elevation myocardial infarction. Coronary angiography revealed dissection of all three coronary arteries with involvement of left main stem, which was successfully treated with percutaneous coronary intervention and drug-eluting stents implantation. The peculiarities of the case, toghether with the treatment strategy and the clinical and angiographic six-month follow-up are discussed.