A 32-year-old woman, nulliparous, previously healthy, awakened in the morning due to angina at rest, so she went to the primary emergency service.
The first ECG showed no abnormalities, but one hour later there was ST-segment elevation in the anterior wall.
She was referred to the local hospital where she was studied with emergency coronary angiography which showed dissection of the anterior descending artery at the middle third.
The left ventricle showed mild anterior and apex hypokinesia with preserved global systolic function.
Medical management and anticoagulation with UFH and clopidogrel were decided.
No episodes of angina were repeated, but control coronary angiography at the 8th day with IVUS showed retrograde progression of the dissection to the TRCI, so surgical treatment was decided.
During the intervention, clear signs of dissection of the anterior descending artery were observed up to its middle third.
Possible spontaneous repair of the dissection, as described in the literature5, was decided to perform venous graft revascularization due to the probability of arterial duct obstruction.
Using the same previous surgical technique, the anterior descending and a branch of the circumflex are revascularized.
There were no complications and the patient was discharged on day 7.
No new episodes of angina have been reported during outpatient follow-up.
Two months later, a coronary angioCT showed that the venous grafts are permeable, the dissection was healed and the arterial lumen recovered.
