Spontaneous Coronary Artery Dissection (SCAD) Complicated With Post-Infarction Ventricular Septal Rupture and a Comparative Review on Mechanical Complications Related With SCAD

• Published in: Current problems in cardiology 2023-08, Vol.48 (8), p.101229-101229, Article 101229
• Main Authors: Ahmed, Taha, Honaker, Olivia, Misumida, Naoki, Messerli, Adrian W.
• Format: Article
• Language: English
• ISSN: 0146-2806; 1535-6280
• DOI: 10.1016/j.cpcardiol.2022.101229

Spontaneous coronary artery dissection (SCAD) is not uncommon but remains arguably an under-diagnosed etiology for acute coronary syndrome (ACS). It occurs predominantly in young-to-middle aged women who have no or few traditional atherosclerotic cardiovascular disease risk factors. Post-infarction mechanical complications are a dreaded outcome of ACS. However, very few case reports describe these mechanical complications related to SCAD. Unsuccessful revascularization is a particular concern for patients presenting with SCAD-induced ACS, which can increase the risk for certain mechanical complications. We present a case of a middle-aged woman who presented with anterior ST-segment elevation myocardial infarction and was found to have SCAD of left anterior descending coronary artery. Two attempts at revascularization were unsuccessful. Thereafter, her clinical course was complicated by the development of heart failure as a result of a reduced ejection fraction and a left ventricular pseudoaneurysm. Importantly she also suffered a ventricular septal rupture necessitating surgical intervention. Fortunately, our patient had a favorable longer-term outcome. Current literature, including five published case reports on SCAD complicated by mechanical complications are reviewed. Clinicians must remain aware of post-infarction mechanical complications in patients with high-risk and non-revascularized SCAD.