Recurrent Primary Coronary Artery Dissecting Aneurysm (hematoma)

A 40-year-old man with recurrent spontaneous (non-iatrogenic) primary coronary artery dissecting aneurysm (hematoma) apparently survived long enough to permit spontaneous healing of the first coronary arterial lesion, as well as the myocardial infarct that accompanied it. Death was due to a recent myocardial infarct, located at a different site than the first one, and caused by a recent coronary artery dissection, involving a different coronary artery. The nature of the coronary artery disease was not identified until the time of necropsy. It was not related to coronary atherosclerosis, or demonstrable systemic vascular disease. Spontaneous primary coronary artery dissecting aneurysm is a rare condition. Survival, with complete healing, without the aid of surgical therapeutic intervention, has not yet been reported. The finding of a healed myocardial infarct, in the presence of grossly normal appearing coronary arteries, indicates a necessity for extremely careful histologic examination, including use of special staining procedures of the arteries supplying the areas of infarction.