Ertan AKBAY, Orhan ONALAN, Adem ADAR, Fahri ÇAKAN

Medikal Tedavi ile İyileşen Yaygın, İdiyopatik, Tekrarlayan Spontan Koroner Arter Diseksiyonu

Spontan koroner arter diseksiyonu, ani kardiyak ölüm ve akut koroner sendromun nadir bir nedenidir ve özellikle genç kadınları etkiler. Bu durumun tedavisi hastanın klinik özelliklerine, hemodinamik ve anjiyografik bulgularına bağlıdır, ancak hastalığın nadir olması nedeniyle son döneme kadar kılavuz desteği yetersizdi. Hastanın ve koroner kan akımının durumuna göre tedavide medikal gözlem, perkütan koroner girişim ya da koroner arter bypass greft cerrahisi kullanılmaktadır. Dört yıl önce spontan sol ana koroner arter diseksiyonu sonrası acil koroner arter bypass greft cerrahisi uygulanan ve yakın zamanda sağ koroner arterinde yaygın spontan koroner arter diseksiyonu tanısı alan genç bir kadın hastayı sunuyoruz. Teşhisin ardından hasta medikal tedavi ile takip edildi ve tamamen iyileşti.

Anahtar Kelimeler:

spontan koroner arter diseksiyonu, akut koroner sendrom, koroner arter hastalığı

Extensive, Idiopathic, Recurrent, Spontaneous Coronary Artery Dissection Healed With Medical Treatment

Spontaneous coronary artery dissection is a rare cause of sudden cardiac death and acute coronary syndrome, and mainly affects young female. Treatment of this condition depends on the clinical features, hemodynamic and angiographic findings of the patient, but due to the rarity of the disease, guideline support was insufficient until the last period. Depending on the condition of the patient and the coronary blood flow, medical observation, percutaneous coronary intervention or coronary artery bypass graft surgery are used in the treatment. We present a young female patient who underwent emergency coronary artery bypass graft surgery after spontaneous left main coronary artery dissection four years ago and was recently diagnosed with extensive spontaneous coronary artery dissection in her right coronary artery. After the diagnosis, the patient was given medical treatment and recovered completely.

Keywords:

spontaneous coronary artery dissection, acute coronary syndrome, coronary artery disease,

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Gilhofer TS, Saw J. Spontaneous coronary artery dissection: update 2019. Curr Opin Cardiol. 2019;34(6):594-602.
Di Fusco SA, Rossini R, Zilio F, Pollarolo L, di Uccio FS, Iorio A, et al. Spontaneous coronary artery dissection: Overview of pathophysiology. Trends Cardiovasc Med. 2021;[Epub ahead of print]. doi: 10.1016/j.tcm.2021.01.002.
Nishiguchi T, Tanaka A, Ozaki Y, Taruya A, Fukuda S, Taguchi H, et al. Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2016;5(3):263-70.
Hill SF, Sheppard MN. Non-atherosclerotic coronary artery disease associated with sudden cardiac death. Heart. 2010;96(14):1119-25.
Cetin E, Ozyuksel A. Beating heart myocardial revascularisation of a sudden cardiac death survivor with spontaneous coronary artery dissection: pitfalls from diagnosis to surgery. BMJ Case Rep. 2014;2014:bcr2014207188.
Kim ESH. Spontaneous coronary-artery dissection. N Engl J Med. 2020;383(24):2358-70.
Iismaa SE, Hesselson S, McGrath-Cadell L, Muller DW, Fatkin D, Giannoulatou E, et al. Spontaneous coronary artery dissection and fibromuscular dysplasia: vasculopathies with a predilection for women. Heart Lung Circ. 2021;30(1):27-35.
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-367.
Eleid MF, Tweet MS, Young PM, Williamson E, Hayes SN, Gulati R. Spontaneous coronary artery dissection: challenges of coronary computed tomography angiography. Eur Heart J Acute Cardiovasc Care. 2018;7(7):609-13.
Takahashi T, Okayama H, Matsuda K, Yamamoto T, Hosokawa S, Kosaki T, et al. Optical coherence tomography-based diagnosis in a patient with ST-elevation myocardial infarction and no obstructive coronary arteries. Int J Cardiol. 2016;223:146-8.
Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS, et al. Spontaneous coronary artery dissection: revascularization versus conservative therapy. Circulation. Circ Cardiovasc Interv. 2014;7(6):777-86.
Alfonso F, Paulo M, Lennie V, Dutary J, Bernardo E, Jiménez-Quevedo P, et al. Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a "conservative" therapeutic strategy. JACC Cardiovasc Interv. 2012;5(10):1062-70.
Gómez-Hospital JA, Ariza-Solé A. Spontaneous coronary artery dissection: a benign entity? Rev Esp Cardiol (Engl Ed). 2021;74(1):2-4.
Lempereur M, Fung A, Saw J. Stent mal-apposition with resorption of intramural hematoma with spontaneous coronary artery dissection. Cardiovasc Diagn Ther. 2015;5(4):323-9.
Lobo AS, Cantu SM, Sharkey SW, Grey EZ, Storey K, Witt D, et al. Revascularization in patients with spontaneous coronary artery dissection and ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2019;74(10):1290-300.
Shoja T, Basman C, Jain S, Mangla A, Lasic Z. Postpartum sudden cardiac death after spontaneous coronary artery dissection in a patient with fibromuscular dysplasia. Cardiol Res. 2017;8(6):327-30.
Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014;7(5):645-55.
Kok SN, Tweet MS. Recurrent spontaneous coronary artery dissection. Expert Rev Cardiovasc Ther. 2021;19(3):201-10.