Bertrand E, Seka R, Adoh M, Dori R N, Odi-Assamoi M, Cailleau G, Chauvet J
Hôpital Nord, Marseille.
Arch Mal Coeur Vaiss. 1993 Feb;86(2):249-53.
The authors report the case of a 34 year old woman with postpartum myocardial infarction due to spontaneous coronary dissection of the distal circumflex artery. A spontaneously regressive spasm of the right coronary artery was also observed. The outcome with heparin, glyceryl trinitrate and calcium antagonist therapy was favourable. Over one year later, coronary angiography showed total resolution of the dissection and a large aneurysm of the inferior and septal walls of the left ventricle. This case is an example of post-partum spontaneous coronary dissection, in a particular vascular context. There are, however, other causes of spontaneous coronary artery dissection (atherosclerosis, eosinophilic syndrome...). Spasm may aggravate the consequences of coronary artery dissection and cause worse myocardial damage. The medical treatment, especially with regards to thrombolytic therapy, requires further codification.
作者报告了一例34岁女性产后因左旋支动脉远端自发性冠状动脉夹层导致心肌梗死的病例。还观察到右冠状动脉出现自发性消退性痉挛。肝素、硝酸甘油和钙拮抗剂治疗的效果良好。一年多后,冠状动脉造影显示夹层完全消失,左心室下壁和室间隔出现一个大动脉瘤。该病例是特定血管背景下产后自发性冠状动脉夹层的一个例子。然而,还有其他导致自发性冠状动脉夹层的原因(动脉粥样硬化、嗜酸性粒细胞综合征……)。痉挛可能会加重冠状动脉夹层的后果,并导致更严重的心肌损伤。药物治疗,尤其是溶栓治疗,需要进一步规范。