An Autopsy Investigation of Dissections of the Coronary Arteries and Bypass Grafts
CD Tan, M Aron, ER Rodriguez. Cleveland Clinic, Cleveland, OH
Background: Coronary arterial dissections may be restricted to the coronary arteries or may occur as an extension of aortic dissection. Spontaneous dissections of the coronary arteries are uncommon with two-thirds of patients dying suddenly. In the hospital setting, iatrogenic coronary arterial dissections are well-documented but rare complications of cardiac catheterization, percutaneous coronary intervention (PCI) and cardiac surgery. Dissections of internal mammary artery or saphenous vein grafts are even more rarely documented in the literature. The purpose of this study was to determine the presentation, associations and outcome of dissections of the coronary arteries and bypass grafts.
Design: A search of the autopsy records from 1993 to 2008 for coronary dissections including both native and bypass grafts was performed.
Results: A total of 17 cases of dissections of the coronary arteries and bypass grafts were found. There were 10 women and 7 men with age ranging from 28 to 82 (median age of 62). Dissections of native coronary arteries (11 cases; 8 female:3 male) involved the left coronary arteries in all but 1 patient. Four patients had secondary coronary dissection occurring as an extension of acute ascending aortic dissection while iatrogenic etiology was due to PCI (4) and aortic valve replacement (2). One patient with segmental mediolytic arteriopathy who died of hemoperitoneum was found to have dissection of the left circumflex artery. There were 6 cases (2 female:4 male) of dissections of bypass grafts identified with involvement of the internal mammary artery graft in 4 and saphenous vein graft in 2. Five patients in this latter group underwent coronary artery bypass grafting and one occurred as a complication of aortic valve replacement. Majority of patients (59%) died of myocardial infarction within 1 to 4 days.
Conclusions: Iatrogenic and secondary dissections of native coronary arteries were more common in females and usually involves the left coronary arteries. In contrast, dissections of bypass grafts was observed more frequently in males and were associated with cardiac surgery. Segmental mediolytic arteriopathy is a rare cause of spontaneous coronary dissection.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 24, Wednesday Afternoon