[Acute type A aortic dissection combined with surgical treatment with acute myocardial infarction]

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Aortic Diseases

Background:

• Acute myocardial infarction (MI) secondary to coronary malperfusion from acute type A aortic dissection (aTAAD) is a significant predictor of operative mortality.
• Diagnosis of this complication can be achieved via electrocardiography and echocardiography.
• The utility of immediate coronary angiography and/or intervention in these critical patients remains debated due to time constraints and added physiological stress.

Observation:

• A case is presented where a patient experienced acute myocardial infarction secondary to acute type A aortic dissection.
• Initial management involved successful percutaneous transluminal coronary angioplasty (PTCA) for the acute MI.
• Subsequent diagnosis of the aortic dissection led to emergent surgical intervention.

Findings:

• The case demonstrates that prompt coronary intervention, specifically PTCA, can be a viable initial strategy in managing acute MI associated with aTAAD.
• This approach successfully addressed the ischemic cardiac event.
• The patient subsequently underwent necessary surgical repair for the aortic dissection.

Implications:

• This case highlights the potential mandatory role of early coronary intervention in select patients presenting with acute myocardial infarction and acute type A aortic dissection.
• It suggests that a staged approach, prioritizing revascularization, may be beneficial despite the complexity.
• Further investigation into the optimal timing and indications for coronary intervention in aTAAD is warranted.