Lahidheb Dhaker, Riahi Leila, Filali Thouraya, Dhamani Rana, Fehri Wafa, Haouala Habib
Service de Cardiologie, Hôpital Militaire de Tunis, Tunis, Tunisia.
J Cardiol Cases. 2012 Jan 18;5(2):e73-e75. doi: 10.1016/j.jccase.2011.12.002. eCollection 2012 Apr.
Myocardial infarction complicates approximately 1 in 10,000 pregnancies [1]. Coronary artery dissection is the leading cause of pregnancy-related myocardial infarction during the postpartum period. Proposed etiologies include altered endocrine status, hemodynamic stress, eosinophilic inflammatory infiltrate, and disruption of vasa vasorum. Definitive diagnosis is made by coronary angiography. Treatment has not been well defined. Strategies include medical management, stenting, and coronary artery bypass grafting. Here, we report the postpartal dissection of all 3 coronary arteries and of the left main coronary in an in vitro-fertilized, 40-year-old woman who, after giving birth to a newborn by cesarean section, presented with myocardial infarction and required urgent coronary artery bypass surgery. Spontaneous coronary dissection that predominantly affects young women is rare and is often dramatic. One-third of the cases occur during pregnancy or in the postpartum period. Our case report is unique; postpartum coronary artery dissection in a patient of any age that was fertilized in vitro is very rare.
心肌梗死在大约每10000例妊娠中会出现1例并发症[1]。冠状动脉夹层是产后与妊娠相关心肌梗死的主要原因。推测的病因包括内分泌状态改变、血流动力学应激、嗜酸性炎症浸润以及血管滋养管破坏。通过冠状动脉造影进行明确诊断。治疗方法尚未明确界定。治疗策略包括药物治疗、支架置入和冠状动脉旁路移植术。在此，我们报告了一名40岁体外受精女性产后所有3支冠状动脉及左主干冠状动脉夹层的病例，该女性剖宫产分娩一名新生儿后出现心肌梗死，需要紧急进行冠状动脉旁路手术。自发性冠状动脉夹层主要影响年轻女性，较为罕见且病情往往严重。其中三分之一的病例发生在孕期或产后。我们的病例报告很独特；任何年龄的体外受精患者产后发生冠状动脉夹层都非常罕见。
