ABSTRACT
A tear into the dissected artery was identified in the 1 patient in whom coronary bypass grafting was performed. It is speculated that the presumed sudden development of systolic hypertension in the coronary arteries of these 2 patients was an important factor underlying the dissection. Patient 3, who had had aortic valve replacement 4 years earlier, died of congestive cardiac failure secondary to an obstructing prosthetic thrombus. A healed myocardial infarction was present in the anterior wall of the left ventricle. In each case the medial hematoma developed in the outer media and separated the adventitia from the media. If this condition is suspected, a catheter passed via the aorta into the coronary artery might demonstrate an obstructed lumen, and appropriate operative correction could then be attempted. Isolated coronary arterial dissection after injection of contrast material into a coronary artery has been suspected during life in several patients and confirmed by anatomic studies in 1.
