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An uncommon presentation of acute type A aortic dissection: left main coronary artery obstruction

Pierre-Yves Courand1, Raphaël Dauphin, Eric Roussel

  • 1Service de Cardiologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, Lyon Cedex 04, France. pycourand@hotmail.com

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|June 15, 2011
PubMed

Insights

Acute aortic dissection can mimic acute coronary syndrome, sometimes involving the left main coronary artery. This rare presentation can lead to misdiagnosis and delayed treatment for aortic dissection.

Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Acute aortic dissection (AAD) is a life-threatening condition with diverse clinical presentations.
  • Misdiagnosis of AAD as acute coronary syndrome (ACS) can lead to inappropriate management and adverse outcomes.

Observation:

  • A 64-year-old male presented with ST elevation in aVR and diffuse ST depression, suggestive of ACS.
  • Coronary angiography was attempted for primary percutaneous coronary intervention but failed due to inability to catheterize the left main coronary artery.

Findings:

  • Aortography and transesophageal echocardiography confirmed Stanford type A aortic dissection.
  • The dissection involved the ostium of the left main coronary artery, causing obstruction.

Implications:

  • This case highlights the critical importance of considering aortic dissection in patients with atypical ACS presentations.
  • Left main coronary artery involvement in Stanford type A aortic dissection is a rare but critical complication.
  • Prompt and accurate diagnosis is essential for appropriate management and improved patient outcomes in aortic emergencies.

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