Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
A 64-year old man with previous coronary artery bypass grafting was admitted to the hospital with acute ST-elevation myocardial infarction. Three days before admission, multislice computed tomography (MSCT, SOMATOM Sensation Cardiac 64, Siemens Medical System, Forchheim, Germany) was performed due to an ECG abnormality. This revealed inverted T waves in leads V5 and V6 without symptoms. MSCT showed spontaneous coronary dissection in the diagonal branch (Panel 1A through F). Coronary angiography after admission demonstrated total occlusion of the diagonal branch (Panel 2A). Immediate percutaneous coronary intervention was undertaken, and coronary stents were successfully implanted with an excellent final angiogram (Panel 2B). ...
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