pontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction (MI). We report a 66-year-old Japanese man who had had an anterior wall MI caused by SCAD of the left anterior descending (LAD) coronary artery and who later developed a left ventricular aneurysm (LVA) despite the dissection having completely disappeared. Case Report A 61-year-old Japanese man was admitted to hospital after an anteroseptal myocardial infarction (MI), which had occurred at rest. The coronary

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... iogram taken at that time revealed SCAD of the LAD without significant stenosis (Fig 1) , and catheter intervention was not performed. He was discharged after rehabilitation, and was followed with medication at the outpatient clinic. Five years later, echocardiography revealed a mural thrombus at the apex of the left ventricle (LV) accompanied by an aneurysm. Anticoagulant therapy with warfarin sodium was started, but the LV ejection fraction (EF) decreased and he was admitted to hospital for surgical treatment of the aneurysm and thrombus. Physical examination revealed a healthy man, 166 cm tall and weighing 69 kg. His blood pressure was 106/74 mmHg, and his pulse was 59 beats/min and regular. There were no stigma of connective tissue disorder. The electrocardiogram (ECG) confirmed the previous anteroseptal MI. Although the preoperative coronary angiogram (CAG) did not show any stenosis in the LAD and the dissection had completely healed, the left ventriculogram (LVG) showed LVA and a dilated LV with an EF of 21.3% (Fig 2) . During surgery, we observed an old thrombus (3 g) in the Circ J 2002; 66: 972 -973 Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction (MI). A 66-year-old Japanese man, who had had an anterior wall MI caused by SCAD of the left anterior descending coronary artery, developed left ventricular aneurysm 5 years later, with depressed left ventricular function and thrombus observed on echocardiography. Left endoventricular circular patch plasty according to Dor's technique was performed without coronary artery bypass grafting, because of the absense of significant coronary artery stenosis on the preoperative coronary angiogram. The clinical course of SCAD in the late phase is generally favorable, but because the prognosis of SCAD is uncertain, patients with SCAD should be carefully followed. (Circ J 2002; 66: 972 -973)