Complete atrioventricular block during thoracic endovascular aortic repair

Area of Science:

• Cardiology
• Vascular Surgery
• Emergency Medicine

Background:

• Acute coronary syndrome (ACS) and acute aortic syndrome (AAS) are distinct but potentially overlapping medical emergencies.
• Concurrent ACS and AAS present significant diagnostic and therapeutic challenges.
• Thoracic aneurysms are a critical consideration in patients presenting with chest pain.

Observation:

• A patient with ACS and a thoracic aneurysm underwent thoracic endovascular aortic repair (TEVAR).
• Perioperative complications included complete atrioventricular block and ST-elevation myocardial infarction.
• The case underscores the complexity of managing comorbid ACS and AAS.

Findings:

• Elevated troponin I and the presence of a thoracic aneurysm necessitate simultaneous consideration of both ACS and AAS.
• Hybrid operating rooms offer a platform for integrated cardiovascular interventions.
• A staged approach, prioritizing coronary catheterization and intervention before TEVAR, is proposed.

Implications:

• This case suggests a potential paradigm shift in managing patients with concurrent ACS and thoracic aneurysms.
• Timely, comprehensive treatment involving combined cardiac and vascular interventions may be crucial.
• Further research is warranted to validate the optimal sequence of interventions in hybrid settings.