Table 1

Summary of findings in post-partum spontaneous CAD and VAD cases
Case ID Presentation Imaging Treatment/ Follow-up
Motreff et al. (2010) 33 F G2P2 2 days post partum ● ECHO: LVEF 58% ● PCI with stent of RCA
● ACS 5 days post partum ● Medical management for VAD
● Vertebral artery dissection
Sharma et al. (2010) 28 F G2P2 10 days post partum ● Coronary CT Angiography: soft plaque in the LAD ● CABG involving LIMA to LAD and saphenous vein bypass graft to OM1
● Non-exertional, intermittent, sub-sternal, sharp chest pain, and left arm numbness ● Coronary angiogram: 90% eccentric stenosis in the ostial LAD extending to first septal perforator and dissection of the LCx ● In OR: Healed dissection in LCx and fresh dissection in LAD
● Intermittent bi-frontal headache ● IVUS: dissection flap in LAD with flow only in true lumen and intraluminal filling defect along entire course of LCx through AV groove ● Medical therapy: ASA Metoprolol, Simvastatin, Coumadin x 6 weeks
● EKG STEMI V1-V2 ● MRA cervicocephalic vessels: 50% stenosis with a double lumen in mid-cervical left vertebral artery consistent with dissection ● MRA (6 weeks later): healed vertebral artery dissection and clinically free of symptoms
● CK and Troponin elevated
Cenkowski et al. (2012) 35 F G2P2 7 months post partum ● EKG: Inferior STEMI 7 months post partum
● Sudden onset retrosternal chest pain radiating to jaw, nausea, vomiting ● Coronary angiography: distal dissection of OM2 ● Coronary artery dissection distal and not amenable to percutaneous repair
8 months post partum ● Transthoracic echo: mild hypokinesis basal inferior wall and EF 50-55% ● Medical therapy: ASA, Clopidogrel, Metoprolol, Ramipril, Simvastatin
● Diplopia, numbness to left arm and face ● CT angiography: 8mm dissection R vertebral artery in its V1 segment ● Medical therapy: Warfarin x 6 months in addition to ASA and Clopidogrel

STEMI, ST elevation myocardial infarction; EF, ejection fraction; LAD, left anterior descending coronary artery; LCx, left circumflex coronary artery; OM2, second obtuse marginal branch; OM1, first obtuse marginal branch; CABG, coronary artery bypass graft; CT, computed tomography; LIMA, left internal mammary artery.

Cenkowski et al.

Cenkowski et al. BMC Pregnancy and Childbirth 2012 12:122   doi:10.1186/1471-2393-12-122

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