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[Acute aortic dissection with left main coronary malperfusion treated with precedent stenting followed by a

Junichi Shimamura1, Hiroshi Kubota, Kunihiko Tonari

  • 1Department of Cardiovascular Surgery, Kyorin University School of Medicine, Mitaka, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|July 29, 2010
PubMed

Insights

Acute aortic dissection can cause fatal coronary malperfusion. Prompt percutaneous coronary intervention to the left main trunk, before surgery, can stabilize patients with acute myocardial infarction and cardiogenic shock.

Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Vascular Medicine

Background:

  • Acute aortic dissection (AAD) can lead to coronary malperfusion, a rare but life-threatening complication.
  • Compression of the left main trunk (LMT) by a false lumen in AAD can cause acute myocardial infarction (AMI) and cardiogenic shock.

Observation:

  • A case of AMI with cardiogenic shock was observed, resulting from LMT compression by a Stanford type A AAD.
  • The patient underwent successful percutaneous coronary intervention (PCI) to the LMT, followed by definitive surgical repair under stable hemodynamic conditions.

Findings:

  • Precedent PCI to the LMT effectively relieved global ischemia and achieved hemodynamic stability.
  • This approach facilitated subsequent definitive surgery for Stanford type A AAD.

Implications:

  • While LMT stenting in AAD is debated, precedent PCI may be a crucial strategy for managing AMI and cardiogenic shock.
  • This case highlights the potential benefit of PCI as a bridge to surgery in complex AAD cases.

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