Postpartum coronary artery dissection: emergency coronary artery bypass with ventricular assist device support.
Acute myocardial infarction during pregnancy and in the puerperium is a rare event: the incidence ranges from 1 per 10,000 to 1 per 30,000 deliveries. Although the etiology is unknown, the pathology may involve thrombosis, spasm, or dissection of the coronary artery. We present the case of a 34-year-old white woman who presented to our institution in cardiogenic shock after an acute myocardial infarction 2 weeks postpartum. This case reinforces the concept that postpartum coronary artery dissection is a fatal disorder. We were able to successfully support the myocardium and the end-organs with a ventricular assist device. We performed concomitant coronary artery bypass grafting in an attempt to salvage the remaining myocardium. Management with emergency coronary revascularization and ventricular assist device support is described.
Samuels
L E
LE
Allegheny University Hospitals, Hahnemann Division, Philadelphia, PA 19102-1192, USA.
Kaufman
M S
MS
Morris
R J
RJ
Brockman
S K
SK
D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D003323:Coronary Aneurysm / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D004630:Emergencies; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000601:surgery*; D011644:Puerperal Disorders / Q000209:etiology / Q000601:surgery*; D012770:Shock, Cardiogenic / Q000209:etiology