title: Surgical management of spontaneous coronary artery dissection.
abstract: Spontaneous coronary artery dissection, which causes acute coronary syndrome and can result in sudden death, is rare; but its true incidence is underestimated, since most patients die suddenly, without diagnosis. The aim of this study was to show the importance of prompt diagnosis and treatment. In reviewing the records of 5,000 consecutive patients who underwent coronary angiography between January 2001 and August 2006, we found 6 cases of spontaneous coronary artery dissection (an incidence rate of 0.12%). Five patients presented with left main coronary artery dissection and 1 patient, with right coronary artery dissection. Angioplasty with stenting failed in the patient with right coronary artery dissection. Coronary artery bypass surgery was performed in all patients. The patient with right coronary artery dissection died of sepsis on the 30th postoperative day. The other 5 patients (83.3%) are still free of symptoms, and they had negative results on stress tests at the 6- and 12-month follow-up visits after coronary artery bypass surgery. The clinical presentation of spontaneous left main coronary artery dissection was similar to that of atherosclerotic disease. However, early diagnosis of spontaneous coronary artery dissection by means of coronary angiography is of paramount importance, because urgent coronary artery bypass grafting can be lifesaving.
authors.affiliation: Department of Cardiovascular Surgery, Dogan Hospital, 34290 Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Unal
authors.forename: Ali Kubilay
authors.initials: AK
authors.lastname: Korkut
authors.forename: Mesut
authors.initials: M
authors.lastname: Kosem
authors.forename: Vedat
authors.initials: V
authors.lastname: Ertunc
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozcan
authors.forename: Nizamettin
authors.initials: N
authors.lastname: Caglar
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D003323:Coronary Aneurysm / Q000473:pathology / Q000601:surgery*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors