Tsianakas Nikolaos, Oehmke Frank, Müller Vera, Lorenz Jakob, Nef Holger, Hamm Christian, Sossalla Samuel, Sander Michael, Meinhold-Heerlein Ivo, Dörr Oliver
Department of Cardiology, University of Giessen, Giessen, Germany.
Department of Gynecology and Obstetrics, University of Giessen, Giessen, Germany.
JACC Case Rep. 2025 Jan 15;30(2):102769. doi: 10.1016/j.jaccas.2024.102769.
We report a case of spontaneous coronary dissection (SCAD) in a 32-year-old pregnant patient during the seventh month of her second pregnancy. A 32-year-old pregnant woman in the 28th week of gestation was referred to our intensive care unit because of angina as well as elevated troponin levels. The initial electrocardiogram and transthoracic echocardiogram (TTE) were normal. Four hours after admission, the patient experienced angina with ST-segment elevation, and the TTE showed de novo apical hypokinesia. The episode lasted approximately 10 minutes, with subsequent resolution of the ST-segment elevation. An emergency coronary angiogram revealed dissection of the left anterior descending artery. A conservative approach with aspirin monotherapy was chosen. Follow-up TTE at 3 months revealed full recovery of left ventricular function. A multidisciplinary approach is crucial in pregnancy-associated SCAD. Conservative management is generally recommended because of the potential for angiographic healing, with percutaneous coronary intervention reserved for severe cases.
我们报告一例32岁孕妇在其第二次怀孕第七个月时发生自发性冠状动脉夹层（SCAD）的病例。一名妊娠28周的32岁孕妇因心绞痛以及肌钙蛋白水平升高被转诊至我们的重症监护病房。最初的心电图和经胸超声心动图（TTE）均正常。入院4小时后，患者出现伴有ST段抬高的心绞痛，TTE显示新发心尖运动减弱。该发作持续约10分钟，随后ST段抬高消失。急诊冠状动脉造影显示左前降支动脉夹层。选择了阿司匹林单药治疗的保守方法。3个月后的随访TTE显示左心室功能完全恢复。多学科方法对于妊娠相关的SCAD至关重要。由于血管造影有愈合的可能，一般建议采取保守治疗，对于严重病例则保留经皮冠状动脉介入治疗。
