Salvage myocardial revascularisation in spontaneous left main coronary artery dissection with cardiogenic shock - the role of mechanical circulatory support.
Spontaneous left main coronary artery dissection is a rare cause of acute coronary events or sudden cardiac death, constituting less than 1% of all epicardial coronary artery dissections. It is often fatal and is mostly recognized at post-mortem examination in young victims of sudden death. More than 70% of the reported cases occurred in women, particularly during pregnancy and the peripartum period and those on oral contraceptives. The clinical presentation is highly variable and prognosis varies widely, depending predominantly on the speed of diagnosis. Treatment options include medical therapy, revascularization with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and mechanical circulatory support in cases of cardiogenic shock. We report a case of spontaneous dissection of the left main stem coronary artery, with extension into the left coronary territory, which occurred in a 41-year-old lady, complicated by profound cardiogenic shock requiring recovery with extracorporeal mechanical circulatory support after salvage myocardial revascularization.
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Ashok
A
Padukone
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Ahmed K
AK
Sayeed
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Nandor
N
Marczin
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Diana
D
García Sáez
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Bartlomiej
B
Zych
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Prashant N
PN
Mohite
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Mohamed
M
Zeriouh
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Robert D
RD
Smith
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Andre R
AR
Simon
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Anton
A
Sabashnikov
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, UK.
Aron-Frederik
AF
Popov
D000328:Adult; D001026:Coronary Artery Bypass / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology* / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D009206:Myocardium / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012770:Shock, Cardiogenic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D014652:Vascular Diseases / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery / Q000628:therapy
cardiogenic shock; mechanical circulatory support; spontaneous left main coronary artery dissection