Postpartal dissection of all coronary arteries in an in vitro-fertilized postmenopausal woman.
Myocardial infarction complicates approximately 1 in 10,000 pregnancies. Although coronary artery dissection is the leading cause of pregnancy-related myocardial infarction during the postpartum period, the pathogenesis of coronary dissection during this period remains uncertain.Herein, we report the case of a 52-year-old black postmenopausal woman with no apparent cardiovascular risk factors who gave birth to twins after in vitro fertilization. Ten days after delivery, she presented with an acute coronary syndrome. Coronary angiography revealed dissection of all 3 coronary arteries. Despite aggressive medical management, the patient experienced recurrent myocardial ischemia. Repeat coronary angiography revealed progression of the dissection process, which required urgent coronary artery bypass surgery. The patient's postoperative course was uneventful. To our knowledge, this report is the 1st description of pregnancy-associated coronary artery dissections in a postmenopausal woman, and the 1st such event in a pregnancy that resulted from in vitro fertilization.
Karadag
Bilgehan
B
Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University, 34098 Istanbul, Turkey. karadag@istanbul.edu.tr
Roffi
Marco
M
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006801:Humans; D050498:Live Birth; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D017698:Postmenopause; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D016896:Treatment Outcome; D014427:Twins
D002317:Cardiovascular Agents