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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Conservatively treated coronary malperfusion associated with acute type A dissection before aortic root replacement.
Sokichi Kamata1, Toshihiro Funatsu1, Yoshito Itou1
1Department of Cardiovascular Surgery, Rinku General Medical Center, Izumisano, Japan.
Journal of Cardiology Cases
|October 4, 2018
Summary
Conservative management can improve coronary malperfusion in acute type A aortic dissection. Electrocardiogram-gated cardiac computed tomography aids diagnosis and guides treatment for this critical condition.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Coronary malperfusion in aortic dissection typically necessitates aggressive surgical or catheter-based revascularization.
- Acute type A aortic dissection presents a significant risk of myocardial ischemia due to compromised coronary artery flow.
Observation:
- An 81-year-old female presented with circulatory shock and ECG evidence of myocardial infarction.
- Initial fluid resuscitation normalized blood pressure and resolved ischemic ECG changes within 20 minutes.
- ECG-gated cardiac multidetector computed tomography revealed type A aortic dissection involving the left main trunk.
Findings:
- The dissection originated 5 mm below the left coronary ostium, causing coronary malperfusion.
- The patient's coronary malperfusion demonstrated transient improvement with conservative management (fluid resuscitation).
- Successful composite graft replacement of the aortic root was performed under stable hemodynamic conditions.
Implications:
- Emergency clinicians should consider conservative management for coronary malperfusion in select acute type A aortic dissection cases.
- ECG-gated cardiac multidetector computed tomography is a valuable diagnostic and management tool for aortic dissection with coronary involvement.
- This case highlights the potential for non-surgical interventions to temporarily stabilize coronary perfusion before definitive aortic repair.
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