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[Myocardial infarction caused by spontaneous coronary artery dissection associated with significant mitral
S Uchita1, S Watanabe, M Ogawa
1Department of Cardiovascular Surgery, Hokko Cardiovascular Hospital, Sapporo, Japan.
Insights
This case report details a rare instance of spontaneous coronary artery dissection in a male patient, leading to significant mitral regurgitation. Surgical intervention successfully addressed both conditions, offering a novel treatment approach.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Spontaneous coronary artery dissection (SCAD) is a rare condition, typically affecting younger women and primarily involving coronary abnormalities.
- Mitral regurgitation (MR) can result from papillary muscle dysfunction, often secondary to myocardial infarction.
Observation:
- A 34-year-old male presented with a history of myocardial infarction attributed to spontaneous dissection of the left circumflex coronary artery.
- The patient also exhibited significant mitral regurgitation due to associated papillary muscle dysfunction.
Findings:
- Surgical management included coronary artery bypass grafting and mitral valvuloplasty.
- A right gastroepiploic artery graft was anastomosed to the right coronary artery, which had also spontaneously dissected.
- Mitral regurgitation was treated with posterior commissure plasty and ring annuloplasty.
Implications:
- This case highlights a unique presentation of SCAD in a male patient with concurrent significant mitral regurgitation.
- The successful surgical outcome suggests a viable treatment strategy for this complex cardiovascular condition.
- This report expands the understanding of SCAD, particularly its association with valvular complications and its occurrence in males.
Abstract:
We experienced a case of 34-year-old male with old myocardial infarction, which seemed to be caused by spontaneous dissection of the left circumflex coronary artery, and associated papillary muscle disfunction with resultant significant mitral regurgitation. He was treated surgically by coronary artery bypass grafting and mitral valvuloplasty. Ungraftable circumflex was abandoned; instead, pediculated graft of the right gastroepiploic artery was anastomosed to the mid-portion of the right coronary artery, which also had been spontaneously dissected. Mitral regurgitation was treated with Reed's plasty of the posterior commissure and the ring annuloplasty using Carpentier-Edwards Ring. His postoperative course has been smooth and uneventful. According to the English literature of the Western hemisphere, spontaneous coronary arterial dissection usually occurs in relatively young people with a striking predilection for women, and nearly all report deal only with the coronary abnormality. To our knowledge, this is the first report of a surgical case of the spontaneous coronary dissection associated with significant mitral regurgitation.