Case Report: Intraoperative Open-Heart Coronary Angiography in Acute Type A Aortic Dissection
Jue Yang1, Xin Li1, Zerui Chen1
1Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
Intraoperative open-heart coronary angiography is a safe and effective method for assessing coronary artery disease in patients with acute type A aortic dissection. This technique avoids the risks associated with conventional angiography, ensuring better patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Acute type A aortic dissection often requires evaluation for concomitant severe coronary artery disease (CAD).
- Conventional coronary angiography poses risks, including dissection extension or aortic rupture, in these high-risk patients.
- Multidetector computed tomography (MDCT) may be insufficient for assessing coronary artery patency in complex aortic cases.
Observation:
- A 50-year-old male with acute type A aortic dissection and prior stenting of the left anterior descending (LAD) artery presented with symptoms.
- Conventional coronary angiography precipitated an aortic rupture.
- Intraoperative open-heart coronary angiography was successfully performed in an emergent setting.
Findings:
- The intraoperative open-heart coronary angiography revealed no significant coronary stenosis.
- The patient underwent a Bentall procedure, total aortic arch replacement, and received an intraoperative descending aortic stent.
- The patient experienced an uneventful postoperative recovery.
Implications:
- Intraoperative open-heart coronary angiography offers a safe and effective alternative for CAD assessment in acute type A aortic dissection.
- This technique can mitigate the risks of conventional angiography in patients with aortic emergencies.
- Successful management highlights the value of adapting diagnostic approaches to complex cardiovascular conditions.
Abstract:
For patients with acute type A aortic dissection, strongly suspected of having concomitant severe coronary artery disease (CAD), preoperative or intraoperative coronary angiography has been recommended. However, conventional selective coronary angiography in this setting may extend the dissection or aortic rupture. We present the use of intraoperative open-heart coronary angiography in a patient with acute type A aortic dissection. A 50-year-old man presented with chest pain and dyspnea and was admitted to our department with acute type A aortic dissection. The patient underwent coronary artery stent implantation in the left anterior descending coronary artery (LAD) 3 years previously due to an acute myocardial infarction. This time we failed to evaluate the patency of the LAD using multidetector computed tomography. An aortic rupture occurred due to conventional coronary angiography, and open-heart coronary angiography was performed. The examination revealed no significant stenosis. A Bentall procedure and total aortic arch replacement were performed, with an intraoperative stent inserted into the descending aorta, and the patient had an uneventful postoperative course. From this case, we learn that intraoperative open-heart coronary angiography is safe and effective in patients with acute type A aortic dissection.
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