Mulvany N J, Ranson D L, Pilbeam M C
Gippsland Pathology Service, Traralgon, Victoria, Australia.
Pathology. 2001 Aug;33(3):307-11.
We present the clinical and postmortem findings in seven adults (four females and three males), who died with dissection of the coronary arteries. The median age was 56 years. Five of the coronary artery dissections (CADs) were spontaneous and two followed trauma: one a motor vehicle accident, the other occurred during angiography. Four cases died suddenly or within 30 minutes. Three had symptoms of at least 24 hours duration and, not unexpectedly, had histological evidence of myocardial infarction. Four dissections involved the left anterior descending coronary artery, two the right coronary artery and one a dominant circumflex artery. Histological examination of the dissected arteries in four cases demonstrated necrosis of the medial smooth muscle which was intimately related to intimal tears and/or an inflammatory reaction. From a review of the literature and this study of seven cases, we conclude that CAD is multifactorial in causation and has a wide spectrum of clinical presentations. Presently the role of coronary vasospasm and prior trauma appears underestimated, and in many cases of CAD the nature of the primary initiating event remains open to speculation.
我们报告了7例死于冠状动脉夹层的成年人（4名女性和3名男性）的临床及尸检结果。中位年龄为56岁。其中5例冠状动脉夹层（CAD）为自发性，2例继发于外伤：1例为机动车事故，另1例发生在血管造影期间。4例突然死亡或在30分钟内死亡。3例有至少持续24小时的症状，不出所料，有心肌梗死的组织学证据。4例夹层累及左前降支冠状动脉，2例累及右冠状动脉，1例累及优势回旋支动脉。4例夹层动脉的组织学检查显示中膜平滑肌坏死，这与内膜撕裂和/或炎症反应密切相关。通过对文献的回顾以及对这7例病例的研究，我们得出结论，CAD的病因是多因素的，临床表现范围广泛。目前，冠状动脉痉挛和既往外伤的作用似乎被低估了，在许多CAD病例中，原发性起始事件的性质仍有待推测。
