左回旋枝特発性冠動脈解離の1剖検例

Abstract

Spontaneous coronary artery dissection is a rare cause of myocardial infarction or sudden death. Most coronary artery dissections occur in the proximal portion of the left anterior descending artery and right coronary artery. We present arare case of acute myocardial infarction with spontaneous coronary dissection in the left circumflex artery. This patient was a 63-year-old woman. She suffered from epigastralgia at rest. She fell into cardiogenic shock state while receiving an upper gastrointestinal series and was admitted to our hospital at an emergency case. The diagnosis of acute lateral myocardial infarction was confirmed by ST elevation in I, aVʟ, V₆ leads of the electrocardi- ogram, elevation of WBC count and cardiogenic enzymes. The emergency coronary angiography showed an obstruction of the proximal portion of the left circumflex artery. She died 6 hours after admission because emergency percutaneous transluminal coronary angioplasty (PTCA) was unsuccessful. Autopsy was performed and coronary dissection was recognized in the same portion with coronary obstruction shown by coronary angiography.