Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography

Abstract

We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures.

Percutaneous coronary intervention of left main pseudoaneurysm with customized covered stents

“…There are no standard recommendations for treatment of coronary pseudoaneurysms [1] and with the limited experience in literature, treatment strategies range from medical management to PCI and surgical revascularization [2,[4][5][6][7]. Our case adds to the list of PCI where covered stents were used to successfully treat aneurysms and pseudoaneurysms.…”

“…The diagnosis of pseudoaneurysm is difficult to make on conventional angiography, and IVUS can be helpful in distinguishing it from a true aneurysm [2][3][4][5][6][7][8][9]. However, some authors have also used the CT coronary angiography for its diagnosis [5,8]. In our patient, IVUS helped in confirming the diagnosis of pseudoaneurysm.…”

Spontaneous Left Main Coronary Artery Dissection and the Role of Intravascular Ultrasonography

“…This proposed pathophysiologic process likely explains the unique appearance of the LMCA seen in our second patient, which has also been reported elsewhere. 7,12 It has been proposed that when present, an intimal tear may actually aid in the decompression of the false lumen and thus is protective. 30 In dissections with an intimal tear and thus false and true lumens, IVUS can permit confirmation of the true versus the false lumen as well as identify the length and morphologic characteristics of the intimal tear.…”

Multidetector Computed Tomography Diagnosis and Cine Imaging of Left Main Coronary Arterial Dissection

“…It may be spontaneous or secondary to various insults to the coronary artery media, such as blunt chest trauma, coronary artery bypass grafting, aortic dissection, invasive coronary angiography (ICA), or percutaneous coronary interventions. [2][3][4] To our knowledge, this is the first published report of the primary diagnosis and dynamic cine interrogation of a left main CD using retrospective ECG-gated MDCT, which was not disclosed on ICA. 1 More recently, electrocardiogram (ECG)-gated multidetector computerized tomography (MDCT) has emerged as a complementary imaging tool primarily for follow-up purposes.…”