Recurrent Spontaneous Coronary Dissection in Puerperium Precipitating in Cardiogenic Shock Prompted Coronary Artery Bypass Grafting

TL;DR

A rare case of heart artery dissection in a young woman after childbirth led to severe heart failure and required surgery.

Contribution

Highlights CABG as an effective treatment for recurrent SCAD in postpartum women when other methods fail.

Findings

SCAD occurred in a 39-year-old postpartum woman, leading to cardiogenic shock.

Drug-eluting stent treatment failed, necessitating coronary artery bypass grafting.

Beta-blockers and advanced imaging are emphasized for managing and diagnosing SCAD.

Abstract

This case report details a rare instance of recurrent spontaneous coronary artery dissection (SCAD) in a 39‐year‐old woman following the delivery of twins, leading to cardiogenic shock. SCAD, although occurring most commonly in middle‐aged women (45–52 years), can also occur in young, otherwise healthy women, in association with pregnancy. In this situation, it poses significant diagnostic and therapeutic challenges, particularly during pregnancy or postpartum periods. This patient's emergency coronary angiography revealed double‐vessel SCAD, and initial treatment with a drug‐eluting stent failed. Surgical intervention with coronary artery bypass grafting (CABG) was ultimately necessary due to recurrent dissection and hemodynamic instability. The case underscores the utility of CABG as a definitive treatment for SCAD, particularly when percutaneous interventions are insufficient. Additionally, the report discusses the importance of early diagnosis using advanced imaging techniques and highlights postoperative management, including beta‐blockers to reduce recurrence risk. This case provides insights into SCAD's complex pathophysiology and the critical role of tailored intervention strategies for young women postpartum.

Graphical summary of postpartum SCAD: (A) ECG with ST‐elevation; (B) surgical revascularization with BIMA and saphenous vein grafts; (C–D) coronary angiography showing RCA and LAD dissection; (E–F) intraoperative subepicardial hematoma of LM and LCx.

Figures