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[Stanford Type A Acute Aortic Dissection with Acute Myocardial Infarction due to Compression of Left Main Coronary

Fuyuki Asami1, Kazuo Yamamoto, Masatake Katsu

  • 1Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|September 26, 2022
PubMed

Insights

Aortic dissection can compress the left main coronary artery, causing myocardial infarction. Stenting the left main artery before surgical repair is an effective treatment strategy for this critical condition.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Imaging

Background:

  • Acute aortic dissection (AAD) is a life-threatening condition often requiring emergent surgical intervention.
  • Left main coronary artery (LMCA) compression by aortic dissection can lead to acute myocardial infarction (AMI), significantly increasing mortality.
  • Timely diagnosis and management are crucial for improving patient outcomes in complex aortic emergencies.

Observation:

  • A 58-year-old male presented with hypotension and left lower extremity ischemia.
  • Electrocardiography revealed ST-segment elevation, and echocardiography showed anteroseptal hypokinesis, indicative of myocardial infarction.
  • Enhanced computed tomography confirmed Stanford type A acute aortic dissection compressing the LMCA.

Findings:

  • Successful left main coronary artery stenting was performed to restore blood flow.
  • A subsequent right external iliac-left femoral artery bypass was conducted.
  • Delayed surgical repair included total aortic arch replacement and frozen elephant trunk procedure with mitral valve repair.

Implications:

  • Left main coronary artery stenting can be a life-saving bridge therapy before definitive surgical repair in acute aortic dissection.
  • This approach effectively manages myocardial infarction secondary to LMCA compression, improving surgical candidacy.
  • Multidisciplinary management involving interventional cardiology and cardiothoracic surgery is vital for complex aortic dissection cases with coronary compromise.

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