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Background  Multiple coronary artery dissection is rare after cardiac surgery. It is difficult to recognize and is easily misdiagnosed as low output syndrome as a result of cardiopulmonary bypass (CPB).    Case presentation  A 43-year-old woman who had undergone cardiac surgery presented with unstable hemodynamics, and progressively increasing lactate, B-type natriuretic peptide, and cardiac enzyme levels, along with electrocardiogram (ECG) changes. Angiography indicated the presence of severe multiple coronary artery dissection, and 3 stents were implanted, which improved the patient’s hemodynamic status and cardiac function.    Conclusions  In the present report, we describe our experience with identifying and treating delayed severe multiple coronary artery dissection caused by cardiac surgery. Timely angiography is vital in patients suspected with coronary artery dissection, and percutaneous coronary intervention (PCI) should be considered as a treatment strategy for cases with severe multiple coronary artery dissection and unstable hemodynamics after cardiac surgery.    Electronic supplementary material  The online version of this article (10.1186/s12893-019-0579-4) contains supplementary material, which is available to authorized users.

bmc surgery

Successful recognition and percutaneous coronary intervention of delayed severe multiple coronary artery dissection caused by cardiac surgery: a case report