Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2022; 10(7): 2341-2350
Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2341
Spontaneous dissection of proximal left main coronary artery in a healthy adolescent presenting with syncope: A case report
Sui-Feng Liu, Ya-Nan Zhao, Chun-Wen Jia, Tian-Yi Ma, Shi-Da Cai, Feng Gao
Sui-Feng Liu, Ya-Nan Zhao, Chun-Wen Jia, Tian-Yi Ma, Shi-Da Cai, Feng Gao, Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
Author contributions: Liu SF contributed to the design of the study and drafted the manuscript; Zhao YN, Cai SD and Gao F performed emergent coronary angiography and percutaneous coronary intervention; Jia CW generated the figures and tables; Ma TY contributed to patient management; Gao F conceived the project and acted as project leader; all authors revised the manuscript critically for important intellectual content and approved the submitted manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Gao, MD, Chief Doctor, Department of Cardiology, Zhongshan Hospital, Xiamen University, No. 201 Hubin South Road, Xiamen 361000, Fujian Province, China. doctor_will@sina.com
Received: October 9, 2021
Peer-review started: October 9, 2021
First decision: November 17, 2021
Revised: November 29, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: March 6, 2022
Processing time: 143 Days and 18.2 Hours
Abstract
BACKGROUND

Spontaneous coronary artery dissection (SCAD) is a frequent cause of acute coronary syndrome in young to middle-aged women with few or no traditional cardiovascular risk factors. Chest pain is the most frequently described presenting symptom, but syncope is extremely rare. Herein, we report on a 16-year-old girl who presented with an episode of syncope occurring during a race. Despite significantly elevated troponin level, the diagnosis of the left main coronary artery SCAD with cardiogenic shock was delayed.

CASE SUMMARY

A 16-year-old girl presented with an episode of syncope. Myocardial injury markers were positive. Echocardiography showed a mildly reduced left ventricular ejection fraction (50%). Although initially stable, she later experienced recurrent chest pain accompanying precordial ST segment elevation with dynamic changes and developed cardiogenic shock, necessitating emergent revascularization. Coronary angiography demonstrated almost total occlusion at the ostium and proximal segment of the left main trunk coronary artery (LMT). Intravascular ultrasound confirmed a false lumen with prominent dissection in the LMT. Percutaneous coronary intervention assisted by intra-aortic balloon pump was conducted in the LMT. A 3.5 mm × 24 mm everolimus-eluting stent was deployed to the focal lesions of the LMT. A postprocedural electrocardiogram showed alleviation of the precordial ST-segment elevation. The diagnosis of SCAD was confirmed. Transthoracic echocardiography showed an improved left ventricular ejection fraction (57%). The patient was asymptomatic during the 24-mo. follow-up period.

CONCLUSION

SCAD should always be considered in the differential diagnosis of acute coronary syndrome presentations in low-risk patients, regardless of age.

Keywords: Spontaneous coronary artery dissection; Intravascular ultrasound; percutaneous coronary intervention; Case report

Core Tip: Spontaneous coronary artery dissection in adolescents is rare. Few such cases have been reported in the existing peer-reviewed medical literature, highlighting the value of documenting the present case. We report a 16-year-old Chinese female case. We performed percutaneous coronary intervention assisted by intra-aortic balloon pump for the left main trunk coronary artery lesion. A good prognosis was confirmed at the 24-mo. follow-up.