Spontaneous dissection of proximal left main coronary artery in a healthy adolescent presenting with syncope: A case report

Table 1 Laboratory data

Complete blood countand coagulation function		Blood biochemistry tests		Cardiac biomarkers and inflammation markers
WBC (109/L)	7.25	ALT (U/L)	61.3	hs-CTnT (ng/L)	1511
NEUT (109/L)	5	AST (U/L)	67	CK (U/L)	142.9
NEUT, %	68.9	ALP (U/L)	154	CK-MB (U/L)	16.5
LY, %	25.2	γ-GTP (U/L)	127.2	LDH (U/L)	440.7
MONO, %	5.5	BUN (mmol/L)	4.35	NT-proBNP (ng/L)	1535
EOS, %	0.3	Cr (µmol/L)	49.7	CRP (mg/L)	8.42
BASO, %	0.1	UA (µmol/L)	399.5	ESR (mm/h)	11.4
RBC (1012/L)	3.83	HbA1c, %	5.5	RF (IU/mL)	0
Hb (g/L)	119	Glucose (mmol/L)	7.56	Complement C3 (g/L)	1.13
PLT (109/L)	237	TC (mmol/L)	3.7	Complement C4 (g/L)	0.27
D-dimmer (mg/L)	1.5	TG (mmol/L)	0.74	Antinuclear Antibodies	Negative
PT (s)	11.9	LDL-C (mmol/L)	2.15	Antineutrophil cytoplasmic antibodies	Negative
APTT (s)	28.6	HDL-C (mmol/L)	1.09	Aticardiolipin antibody	Negative

WBC: White blood cell; NEUT: neutrophil granulocyte; LY: Lymphocyte; MONO: Monocyte; EOS: Eosinocyte; BASO: Basocyte; RBC: Red blood cell; Hb: Hemoglobin; Plt: Platelet; PT: Prothrombin time; APTT: Activated partial thromboplastin time; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; γ-GTP: Gamma-glutamyl transpeptidase; BUN: Blood urea nitrogen; Cr: Serum creatinine; UA: Uric acid; HbA1c: Hemoglobin A1c; TC: Total cholesterol; TG: Triglyceride; LDL-C: Low-Density Lipoprotein Cholesterol; HDL-C: High-Density Lipoprotein Cholesterol; hs-CTnT: high-sensitivity troponin T; CK: Creatinekinase; CK-MB: Creatine Kinase MB; LDH: Lactic dehydrogenase; NT-proBNP: N-terminal (NT)-pro hormone BNP; CRP: C- reactive protein; ESR: Erythrocyte Sedimentation Rate; RF: Rheumatoid factor.

Table 2 Previous cases reported as spontaneous coronary artery dissection in children and adolescents in English literature

Ref.	Age/Sex	Site	Clinical presentation	Treatment	Possible triggers
Kothari et al[22], 2007	17/Boy	LCX	Unknown	Unknown	SLE
Rohit et al[23], 2008	14/Boy	LMT	Unknown	Medical treatment	Unknown
Uyar et al[17], 2012	17/Girl	LAD	Chest pain	CABG	Neurofibromatosis
Polat et al[18], 2013	13/Boy	LAD	Chest pain	Medical treatment	Caffeinated “energy drinks”
Cropp et al[19], 2013	14/Girl	LMT	Chest pain	CABG	Heavy exercise
Herry et al[21], 2013	18/Boy	LAD	Asymptomatic	Medical treatment	Unknown
Stammschulte et al[20], 2020	6/Boy	RCA	Chest pain	PCI	Methylphenidate use

LCX: Left circumflex coronary artery; LMT: Left main coronary artery; LAD: Left anterior descending artery; RCA: Right coronary artery; SLE: Systemic lupus erythematosus; CABG: Coronary artery bypass graft; PCI: percutaneous coronary intervention.