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.