Engelman D T, Thayer J, Derossi J, Scheinerman J, Brown L
Department of Surgery, University of Connecticut School of Medicine, Farmington 06030-3955.
Conn Med. 1993 Mar;57(3):135-9.
There have been 31 patients with pregnancy related coronary artery dissection reported in the medical literature. We report a case of both right and left coronary artery dissection in a postpartum patient. A collective review of the clinical course, risk factors, and treatment specific mortality rates of coronary artery dissection in near term and postpartum females is discussed. The mean age was 33, the mean parity was 2.7, and the mean time span was 20 days postpartum. Twenty-two percent had known risk factors for coronary artery disease. Eighty-four percent involved the left anterior descending artery. Overall mortality was 66%. Of the patients that were alive on admission, 61% were treated medically (n = 11) with a 64% mortality; 39% were treated surgically (n = 7) with a 0% mortality. We conclude that pregnancy related coronary artery dissection occurs in otherwise healthy women near term or within three months postpartum. Multiparity and advanced maternal age may be risk factors. Early diagnosis and prompt surgical treatment may improve outcome.
医学文献中已报道了31例与妊娠相关的冠状动脉夹层病例。我们报告1例产后患者同时发生右冠状动脉和左冠状动脉夹层的病例。本文讨论了近期和产后女性冠状动脉夹层的临床病程、危险因素及特定治疗死亡率的综合回顾。平均年龄为33岁，平均产次为2.7次，平均时间跨度为产后20天。22%的患者有已知的冠状动脉疾病危险因素。84%的病例累及左前降支动脉。总体死亡率为66%。入院时存活的患者中，61%（n = 11）接受药物治疗，死亡率为64%；39%（n = 7）接受手术治疗，死亡率为0%。我们得出结论，与妊娠相关的冠状动脉夹层发生在近期或产后三个月内其他方面健康的女性中。多产和高龄产妇可能是危险因素。早期诊断和及时手术治疗可能改善预后。
