Postpartum Left Main Spontaneous Coronary Artery Dissection With Shock, Requiring Surgery and Extracorporeal Membrane Oxygenation

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in young women; pregnancy-associated SCAD disproportionately involves the left main coronary artery (LMCA) and cardiogenic shock. CASE SUMMARY: A 34-year-old woman, 3 months postpartum, presented with collapse and chest pain 2 days after resuming menses. Angiography revealed extensive LMCA dissection extending into the left anterior descending and circumflex arteries. Rapid hemodynamic deterioration necessitated emergency bypass grafting and central venoarterial extracorporeal membrane oxygenation for cardiogenic shock. Her course was complicated by pericardial hematoma and pneumonia; she was weaned from mechanical support with ejection fraction recovery to 50%-55%. DISCUSSION: This case represents an exceptionally rare pregnancy-associated SCAD phenotype combining LMCA involvement, cardiogenic shock, and revascularization. TAKE-HOME MESSAGE: Preserved left ventricular function does not exclude impending collapse in LMCA SCAD; menstrual resumption may be an under-recognized hormonal precipitant of pregnancy-associated SCAD; and meaningful recovery is achievable with prompt, multidisciplinary management.