Do we need cardiovascular computed tomography angiography in the setting of acute ST-segment elevation myocardial
Mohamad Jihad Mansour1,2, Layal Mansour3, Clément Bénic3,4
1Department of Cardiology, University Hospital of Brest, 29609, Brest Cedex, France. mohamad_J_mansour@hotmail.com.
Insights
Cardiovascular computed tomography angiography (CCTA) aided in diagnosing acute myocardial infarction in a patient with aortic dissection and a mechanical aortic valve. This imaging technique guided timely interventions for coronary thrombi and ischemia.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Cardiac Surgery
Background:
- The utility of cardiovascular computed tomography angiography (CCTA) is expanding for patients with myocardial injury of uncertain origin.
- Evaluating acute ST-elevation myocardial infarction (STEMI) mechanisms in complex cases remains challenging.
Observation:
- A 51-year-old male with a mechanical aortic valve replacement presented with chest pain and was diagnosed with type A aortic dissection affecting the left main coronary artery ostium via CCTA.
- Following fenestration for the aortic dissection, the patient developed anterior STEMI attributed to left coronary thrombi, visualized by urgent CCTA.
Findings:
- CCTA accurately diagnosed aortic dissection and identified coronary thrombi as the cause of STEMI in a patient with a mechanical aortic valve.
- The imaging facilitated prompt therapeutic decisions, including fenestration, thrombus aspiration, and percutaneous coronary intervention (PCI).
Implications:
- CCTA offers critical diagnostic and therapeutic guidance in complex cardiovascular emergencies involving aortic dissection and myocardial infarction.
- This case underscores the value of CCTA in defining STEMI etiology and guiding vascular access for PCI in high-risk patients.
Abstract:
While the role of cardiovascular computed tomography angiography (CCTA) is evolving in low-intermediate risk patients with myocardial injury due to equivocal causes, this report highlights the added value of CCTA in evaluating the mechanism of acute ST-segment elevation myocardial infarction in a patient with aortic dissection and mechanical aortic valve replacement. CCTA provided accurate diagnosis and guided therapy without delay. A 51-year-old man with mechanical aortic valve replacement was admitted for severe chest pain. CCTA showed type A aortic dissection with an entry tear at the ostial left main coronary artery. Given the high surgical risk, he underwent fenestration of the false lumen. Twelve days postoperatively, he had chest pain with anterior STEMI. Urgent CCTA showed two left coronary thrombi with transmural extensive ischemia. Urgent thrombus aspiration and percutaneous coronary intervention were performed. A drug-eluting stent was placed on the proximal LAD. CCTA was crucial prior to PCI in order to define the etiology of STEMI and evaluate the vascular access.
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