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Dissecting Intramural Hematoma of the Coronary Artery in Pregnancy and the Puerperium

From the Department of Pathology at St. Francis Hospital Hartford, Conn; University of Connecticut Schools of Medicine and Dental Medicine and Yale University School of Medicine, New Haven, Conn.

Abstract

Dissecting intramural hematoma of the coronary artery is an infrequent cause of sudden and unexpected death of women in pregnancy and the puerperium. Three cases are added to the 7 that have been reported in the literature. None of the cases was diagnosed clinically and all were rapidly fatal. The exact etiology has not been definitely established and the possible factors involved are discussed. A combination of two factors resulting in weakening of the coronary artery wall may explain the high incidence of this lesion in pregnancy and the puerperium; these include a) loosening of the ground substance of the connective tissue in pregnancy, and b) effect of hemo-dynamic factors during and after parturition.

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