Case report

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

Shahid Rahman , Mohammed Abdul-Waheed , Tarek Helmy , Lynn C Huffman , Vipin Koshal , Julian Guitron , Walter H Merrill , David F Lewis , Stephanie Dunlap , Yukitaka Shizukuda , Neal L Weintraub , Cristopher Meyer and Mehmet Cilingiroglu

Mehmet Cilingiroglu, Department of Internal Medicine, Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML0542, Cincinnati, OH 45267-0542

author email corresponding author email

Journal of Cardiothoracic Surgery 2009, 4:15doi:10.1186/1749-8090-4-15

Published:	1 April 2009

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.