Emergency heart transplantation in a female patient with acute coronary syndrome caused by pregnancy-associated spontaneous coronary artery dissection: a clinical case

Although spontaneous coronary artery dissection (SCAD) is a rare condition, it should be considered in young women presenting with acute coronary syndrome during the peripartum period. A multidisciplinary approach is essential: timely collaboration among cardiologists, cardiac surgeons, intensivists, and transplant specialists allows for the consideration of heart transplantation (HT) as a last-resort, yet potentially life-saving, intervention in cases of refractory heart failure. Thus, HT expands therapeutic options for managing life-threatening cardiac conditions in obstetric practice. The presented clinical case demonstrates the successful use of heart transplantation as a definitive treatment in a 30-year-old woman with pregnancy-associated SCAD (P-SCAD), following unsuccessful attempts at revascularization, including stenting, balloon angioplasty, and mechanical circulatory support.

1. Gautier SV, Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2024. 17th Report from the Registry of the Russian Transplant Society. Russian Journal of Transplantology and Artificial Organs. 2025; 27 (3): 8–32. [In Russ, English abstract]. doi 10.15825/1995-1191-2025-3-8-32.

2. Zeven K. Pregnancy-associated spontaneous coronary artery dissection in women: a literature review. Curr Ther Res Clin Exp. 2023 Mar 1; 98: 100697. doi: 10.1016/j.curtheres.2023.100697.

3. Saw J, Mancini GJ, Humphries K, Fung A, Boone R, Starovoytov A et al. Angiographic appearance of spontaneous coronary artery dissection with intramural hematoma proven on intracoronary imaging. Catheter Cardiovasc Interv. 2016; 87 (2): E54–E61. doi: 10.1002/ccd.26022.

4. Zainobidinov ShSh, Khelimsky DA, Baranov AA, Badoyan AG, Krestyaninov OV. Modern aspects of diagnosis and treatment of patients with spontaneous coronary artery dissection. Cardiovascular Therapy and Prevention. 2022; 21 (8): 3193. [In Russ, English abstract]. doi: 10.15829/1728-8800-2022-3193.

5. Apostolović S, Ignjatović A, Stanojević D, Radojković D, Nikolić M, Milošević J et al. Spontaneous coronary artery dissection in women in the generative period: clinical characteristics, treatment, and outcome – a systematic review and meta-analysis. Front Cardiovasc Med. 2024; 11: 1277604. doi: 10.3389/fcvm.2024.1277604.

6. Havakuk O, Goland S, Mehra A, Elkayam U. Pregnancy and the risk of spontaneous coronary artery dissection: an analysis of 120 contemporary cases. Circ Cardiovasc Interv. 2017; 10 (3): e004941. doi: 10.1161/CIRCINTERVENTIONS.117.004941.

7. Elkayam U, Jalnapurkar S, Barakkat MN, Khatri N, Kealey AJ, Mehra A, Roth A. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation. 2014; 129 (16): 1695–1702. doi: 10.1161/CIRCULATIONAHA.113.002054.

8. Yip A, Saw J. Spontaneous coronary artery dissection – a review. Cardiovasc Diagn Ther. 2015 Feb; 5 (1): 37–48. doi: 10.3978/j.issn.2223-3652.2015.01.08.

9. Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al. Spontaneous coronary artery dissection: revascularization versus conservative therapy. Circ Cardiovasc Interv. 2014; 7 (6): 777–786. doi: 10.1161/CIRCINTERVENTIONS.114.001659.

10. Saw J, Starovoytov A, Humphries K, Sheth T, So D, Minhas K et al. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. Eur Heart J. 2019; 40 (15): 1188–1197. doi: 10.1093/eurheartj/ehz007.

11. Lempereur M, Fung A, Saw J. Stent mal-apposition with resorption of intramural hematoma with spontaneous coronary artery dissection. Cardiovasc Diagn Ther. 2015; 5 (4): 323–329. doi: 10.3978/j.issn.2223-3652.2015.04.05.

12. Liu J, Yang B, Itoh A, Masood M, Hartupee J, Schilling J. Impact of new UNOS allocation criteria on heart transplant practices and outcomes. Transplant Direct. 2020; 7: e642. doi: 10.1097/TXD.0000000000001088.

13. Murkamilov I, Aitbaev K, Raimzhanov Z, Yusupova T, Yusupov F. Peripаrtal Cardiomyopathy. Bulletin of Science and Practice. 2023; 9 (5): 283–312. [In Russ, English abstract]. doi: 10.33619/2414-2948/90/35.

14. Bouabdallaoui N, Demondion P, Maréchaux S, Varnous S, Lebreton G, Mouquet F, Leprince P. Heart transplantation for peripartum cardiomyopathy: a single-center experience. Arq Bras Cardiol. 2018 Feb; 110 (2): 181–187. doi: 10.5935/abc.20180014.