Non-invasive management of post-partum spontaneous left main coronary artery dissection using cardiac computed tomography angiography

A 34-year-old primigravida had chest pain and dyspnoea 2 h after an urgent cesarean section and a twin delivery. The indication for surgery was premature rupture of membranes at 32 weeks of gestation. Electrocardiogram (ECG) during chest pain showed 2-mm ST-depression in anterior leads and the Troponin T level increased to 174 ng/L (normal <13). The chest pain and ECG changes spontaneously resolved, and an echocardiogram performed later was normal. A clinical diagnosis of non-ST-elevation myocardial infarction with probable spontaneous coronary artery dissection (SCAD) was made and the patient was treated with aspirin, clopidogrel, and bisoprolol. Since the patient was stable, invasive coronary angiography was deferred and a cardiac computed tomography angiography (CCTA) was performed the following day, confirming the diagnosis of SCAD involving the left main (LM) and left anterior descending coronary arteries (A). The patient remained stable and repeat CCTA a week later was normal (B). Six-months follow-up was uneventful and an exercise test performed 2-months post-discharge was normal.

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