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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
PubMed

Insights

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.

Keywords:
Acute type A dissectionCoronary malperfusionElectrocardiogram-gated gated cardiac multidetector computed tomography

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