INTRODUCTION
Spontaneous coronary artery dissection is a rare condition defined as an
automatic separation of the coronary artery wall. It is not iatrogenic,
not related to trauma or atherosclerotic disease. Women are mostly
affected (>70%).(1) Two mechanisms
describe SCAD: a “primary” rupture of coronary endothelium with
resultant dissection of the coronary artery wall or the rupture of the
“vasa vasorum” with formation of an intramural hematoma (IMH).
According to angiographic findings, there are three types of SCAD. Type
I: characterized by contrast dye staining of the arterial wall with
multiple radiolucent lumens. Type II: more diffuse (length
>20mm) and usually presents uniform narrowing of the
coronary vessels. Type III: focal or tubular (<20 mm) stenosis
that mimics atherosclerosis. (2)
The following case illustrates a case of type II SCAD, and the
subsequent evolution into a type A aortic dissection. The details of
surgical management required to salvage the patient are then described,
including ascending and hemi-arch aortic replacement.