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False Coronary Lumen Originating from Left Main Coronary Artery Dissection Causing Acute Myocardial InfarctionA Case ReportKlinikum Lahr, Medizinische Klinik, Abteilung Kardiologie, Lahr, Germany. Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction, which is infrequently diagnosed antemortem. The majority of the previously reported cases were found in women of whom a significant proportion presented during pregnancy or the post partum period. A case is presented of an acute myocardial infarction in a 37-year-old woman, unrelated to pregnancy or the postpartum state, with an unusual spontaneous coronary dissection that was angiographically documented 6 days after thrombolytic therapy. Origi nating in a small dissection in the left main coronary artery, a false lumen parallel to the left anterior descending coronary artery (LAD) with a separation of the lumina of up to 1 mm was found with a reentry of the false lumen into the LAD in its mid portion. Both lumina were perfused and the true lumen of the LAD showed a 50% to 60% diameter stenosis. Because no signs of ongoing ischemia could be detected at rest or during exercise, the patient was treated medically. Two months later, repeat coronary angiography documented a complete obliteration of the false lumen with moderate stenosis of the proximal LAD. Pathophysiologic aspects and treatment options of spontaneous coronary artery dissections are discussed.
Angiology, Vol. 54, No. 3,
353-357 (2003) |
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