Isolated primary dissection of the right coronary artery

A 59 year old female had unstable angina threatening infarction, together with Prinzmetal's syndrome in the postero-diaphragmatic area, and a transient second degree atrio-ventricular block. Selective arteriography revealed complete dissection, as an isolated and primary finding, in the right coronary artery. Operation consisted of dividing the coronary artery at the superior limit of the dissection, of suturing together the separated layers of the artery, and finally an end-to-end aorto-coronary bypass. The patient is living without any functional symptoms 15 months after the initial episode, but a follow-up arteriogram showed that separation of the two layers of the dissection was persisting. This condition has caused rapid or sudden death in 47 of the 51 reported cases, often occurring in females at the beginning of pregnancy. This mortality rate justifies early operation as soon as the diagnosis is made by coronary arteriography.