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Stanford type A acute dissection developing acute myocardial infarction.

N Ohtani1, K Kiyokawa, H Asada

  • 1Department of Cardiovascular Surgery, Shin-Nittetsu Muroran General Hospital, Hokkaido, Japan.

The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|March 14, 2000
PubMed
Summary

A 75-year-old patient presented with epigastric pain and vomiting, later diagnosed with acute myocardial infarction and Stanford type A aortic dissection. Emergency surgery successfully reconstructed the ascending aorta, with the patient recovering well.

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Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Diagnostic Imaging

Background:

  • A 75-year-old female presented with symptoms of acute gastritis, including epigastric pain and vomiting.
  • The patient also reported chest pain and urinary incontinence, prompting further investigation.

Observation:

  • Electrocardiographic findings revealed acute myocardial infarction.
  • Echocardiography and electrocardiography diagnosed diffuse left ventricular infarction and acute aortic dissection (Stanford type A).
  • Intraoperative monitoring showed elevated pulmonary artery pressure and decreased pulse pressure, indicative of acute cardiac tamponade.

Findings:

  • Transesophageal ultrasonography identified the aortic dissection entry in the descending aorta, extending proximally to the aortic valve annulus.

Related Experiment Videos

  • The aortic dissection aneurysm compressed the right and left coronary arteries.
  • Mild aortic insufficiency was noted, necessitating only reconstruction of the ascending aorta.
  • Implications:

    • This case highlights the complex interplay between acute myocardial infarction and Stanford type A aortic dissection.
    • Prompt diagnosis and surgical intervention, including ascending aorta reconstruction, are crucial for managing such critical conditions.
    • Successful management, even with coronary artery compression, emphasizes the importance of tailored surgical approaches and postoperative care.