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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
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Middle-Aged Man With Unstable Angina and an Inaccessible Right Coronary Artery

Kameel Kassab1, Neeraj Jolly2, Aviral Vij1

  • 1Cardiology, John H Stroger, Jr. Hospital of Cook County, Chicago, USA.

Cureus
|November 30, 2020
PubMed

Insights

Retrograde aortic dissection into coronary arteries can cause acute myocardial infarction. Cardiac computed tomography angiography (CCTA) aids diagnosis, leading to surgical management including aortic root replacement and bypass grafting.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Diagnostic Imaging

Background:

  • Type A aortic dissection can retrograde into coronary ostia, causing acute myocardial infarction (AMI).
  • Delayed diagnosis of aortic dissection in patients with acute coronary syndrome (ACS) significantly increases morbidity and mortality.
  • Coronary angiography is crucial for ACS evaluation but may not fully reveal aortic dissection involvement.

Observation:

  • A case of ACS was suspected during coronary angiography.
  • The patient presented with symptoms suggestive of acute myocardial infarction.
  • Retrograde dissection of the aortic root into the coronary ostia was suspected.

Findings:

  • Cardiac computed tomography angiography (CCTA) confirmed retrograde aortic dissection extending into the right coronary artery (RCA).
  • The patient experienced acute coronary syndrome secondary to the dissection.
  • CCTA proved instrumental in diagnosing the coronary involvement from aortic dissection.

Implications:

  • Early recognition of retrograde aortic dissection is critical for patient outcomes.
  • CCTA is a valuable tool for diagnosing aortic dissection involving coronary arteries.
  • Surgical intervention, including aortic root replacement and coronary artery bypass grafting, can be life-saving.

Keywords:
acute coronary syndromeaortic dissectioncardiac computed tomography angiography

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