SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of P-Scad Complicated by Lv-La Communication

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This case describes a rare and highly complex pregnancy-associated spontaneous coronary artery dissection (P-SCAD) in a 27-year-old woman at 28 weeks’ gestation, complicated by multiple cardiac and infectious problems.<br /><br />She presented with fever, gastrointestinal symptoms, headache, myalgias, and then developed acute central chest pain. Emergent coronary angiography showed a Type 1 SCAD involving the left main coronary artery, extending into the LAD and LCx, with total occlusion of the ramus. Transthoracic echocardiography showed reduced ejection fraction (40%), global hypokinesis, and posterior mitral valve leaflet pathology causing moderate mitral regurgitation. She was initially managed conservatively with aspirin and beta-blocker therapy.<br /><br />Her course was further complicated by prolonged MSSA bacteremia and tricuspid valve endocarditis, requiring a 6-week inpatient course of IV oxacillin. At 34 weeks, fetal distress prompted urgent cesarean delivery. Postpartum imaging demonstrated persistent LV dysfunction, a mildly enlarged left atrium, and an aneurysmal segment near the posterior mitral leaflet. Additional evaluation with TEE and cardiac MRI revealed a left ventricular pseudoaneurysm with communication from the LV into the left atrium through a posterior fistulous tract near the mitral annulus.<br /><br />She ultimately underwent coronary artery bypass grafting (LIMA to diagonal branch and saphenous vein graft to obtuse marginal), mechanical mitral valve replacement, and repair of the LV pseudoaneurysm/LV-LA communication.<br /><br />The authors highlight that P-SCAD can be life-threatening and is especially risky in pregnancy due to hormonal effects on the vessel wall. They suspect this patient’s SCAD resulted from combined pregnancy-related vascular vulnerability and chronic cocaine/amphetamine use. They also note that this appears to be the first reported case of antepartum SCAD complicated by endocarditis and LV-LA pseudoaneurysm, underscoring the need for coordinated multidisciplinary care.

Asset Subtitle

Candice K. Park

Meta Tag

Author List Candice K. Park, Saurabh Rajpal

Category Clinical Vignettes

Concept Pregnancy-Associated Spontaneous Coronary Artery Dissection

Concept Spontaneous Coronary Artery Dissection

Concept Multidisciplinary Care

Concept Pregnancy-Related Physiologic Changes

Concept Reduced Ejection Fraction

Distinguished Finalist

Presenter Organization Ohio State University

Presenting Author Candice K. Park

Track Adult

Keywords

pregnancy-associated spontaneous coronary artery dissection

P-SCAD

left main coronary artery

myocardial infarction

mitral regurgitation

tricuspid valve endocarditis

MSSA bacteremia

left ventricular pseudoaneurysm

cesarean delivery

coronary artery bypass grafting

Pregnancy-Associated Spontaneous Coronary Artery Dissection

Spontaneous Coronary Artery Dissection

Multidisciplinary Care

Pregnancy-Related Physiologic Changes

Reduced Ejection Fraction