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Acute type A aortic dissection and left main coronary artery obstruction detected by transesophageal echocardiography

Ahmet Umit Güllü1, Zekeriya Nurkalem, Murat Akçar

  • 1Department of Cardiovascular Surgery, Siyami Ersek Cardiovascular Surgery Center, Istanbul, Turkey.

Turk Kardiyoloji Dernegi Arsivi : Turk Kardiyoloji Derneginin Yayin Organidir
|August 3, 2010
PubMed

Insights

Aortic dissection can affect coronary arteries, causing myocardial ischemia. Surgical repair of ascending aortic dissection involving coronary ostia is complex but feasible, though patient outcomes remain challenging.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Thoracic Surgery

Background:

  • Acute aortic dissection is a life-threatening condition often presenting with chest pain.
  • Myocardial ischemia can be a complication of aortic dissection, mimicking acute coronary syndrome.

Observation:

  • A 63-year-old man presented with chest pain and ST-segment depression, initially suggestive of myocardial ischemia.
  • Computed tomography revealed acute descending aortic dissection, while transesophageal echocardiography identified a Stanford type A dissection involving the left main coronary ostium.
  • The dissection flap partially obstructed the left main coronary ostium, causing intermittent left main coronary occlusion and ventricular tachycardia.

Findings:

  • Emergency surgery revealed ascending aortic dissection extending into the sinus of Valsalva and left main coronary trunk.
  • Coronary arteries were directly suthed to a composite graft, and the ascending aorta was replaced using a Bentall procedure.
  • The patient survived the initial surgery but succumbed to nosocomial pneumonia one month post-operatively.

Implications:

  • This case highlights the critical importance of considering aortic dissection in patients with acute coronary syndrome symptoms.
  • Surgical management of aortic dissection involving coronary ostia requires meticulous technique and carries significant risk.
  • Further research is needed to improve outcomes for patients with complex aortic dissections affecting the coronary arteries.

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