Coronary malperfusion due to flap suffocation after acute type A dissection surgery

Area of Science:

• Cardiology
• Cardiovascular Surgery

Background:

• Type A acute aortic dissection and annulo-aortic aneurysm require prompt surgical intervention.
• Aortic root replacement is a common surgical approach for these conditions.

Observation:

• Post-operative electrocardiogram showed ST-segment depression and T-wave inversion.
• Echocardiography revealed left ventricular asynergy.
• Heart catheterization identified extreme diastolic narrowing of the ascending aorta's true lumen due to flap suffocation, causing coronary malperfusion.

Findings:

• Flap suffocation in the residual ascending aorta led to coronary malperfusion.
• A pullback pressure curve confirmed the mechanism of coronary malperfusion.
• Surgical re-intervention for total arch repair successfully diminished coronary malperfusion.

Implications:

• Coronary malperfusion is a potential complication following aortic root replacement for Type A acute aortic dissection.
• Early recognition and surgical re-intervention are crucial for managing flap-related coronary malperfusion.
• Successful management leads to favorable long-term outcomes in patients with complex aortic pathologies.