[Acute type A aortic dissection with partial disruption of the right coronary ostium; report of a case]

A 64-year-old man with a history of hypertension was admitted to another hospital, presenting with sudden chest pain. Although his symptoms resolved after admission, chest computed tomography (CT) revealed acute type A aortic dissection, and he was referred to our hospital for surgery. On arrival, his hemodynamic status was stable. Electrogram showed no ST-T change, and transthoracic echocardiography demonstrated pericardial effusion, mild aortic regurgitation and good left ventricular wall motion. We immediately decided on an emergency operation. Commencing a median sternotomy, the pericardial cavity was found to be filled with old blood. Standard cardiopulmonary bypass was instituted with right atrial drainage and right femoral arterial return, and with right upper pulmonary venous venting. When antegrade cold blood cardioplegia was selectively administered, we noticed the partial disruption of the upper aspect of the right coronary ostium. The right coronary sinus was resected in a scallop shape. Partial aortic root remodeling using a trimmed tube graft and coronary artery bypass grafting to the right coronary artery with saphenous vein were performed under deep hypothermic circulatory arrest. Weaning from cardiopulmonary bypass was not difficult. The postoperative course was uneventful.