Pregnancy related coronary artery dissection: a case report and collective review

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.