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Spontaneous rupture of coronary artery
Naotaka Motoyoshi1, Tsunehiro Komatsu, Yoshimasa Moizumi
1Department of Thoracic and Cardiovascular Surgery, Sendai City Medical Center, 22-1, Tsurugaya 5-choume, Miyagino-ward, Sendai 983-0824, Japan. naotaka5@hotmail.com
Insights
Spontaneous coronary artery rupture (SCAR) can occur after aortic replacement surgery. This case highlights SCAR diagnosis and successful treatment with bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Imaging
Background:
- Descending aortic replacement is a complex procedure with potential cardiac complications.
- Spontaneous coronary artery rupture (SCAR) is a rare but serious complication following cardiac or aortic surgery.
- Early diagnosis and intervention are critical for managing SCAR.
Observation:
- A patient developed cardiac tamponade three months post-descending aortic replacement.
- Echocardiography confirmed cardiac tamponade, necessitating emergency pericardial centesis.
- Computed tomography initially ruled out aortic dissection.
Findings:
- Selective coronary angiography diagnosed spontaneous coronary artery rupture (SCAR) with leakage from the left circumflex artery.
- The patient underwent successful surgical management.
- Treatment involved rupture site isolation via bilateral ligation and distal revascularization with saphenous vein aortocoronary bypass graft.
Implications:
- This case underscores the importance of considering SCAR in patients presenting with cardiac tamponade after aortic surgery.
- Timely diagnosis using angiography is crucial for identifying SCAR.
- Surgical repair, including bypass grafting, can effectively manage SCAR, improving patient outcomes.
Abstract:
We report a case of spontaneous coronary artery rupture (SCAR) 3 months after descending aortic replacement. Cardiac tamponade was confirmed at first by using echocardiography following emergency pericardial centesis. The patient was denied aortic dissection by computed tomography, thereafter diagnosed as SCAR with selective angiography, which revealed a leakage from the left circumflex branch. The patient underwent successful rupture site isolation by bilateral ligation and distal revascularization with aortocoronary bypass with saphenous vein graft.