Left main ostium dissection due to the ATAAD with coronary malperfusion

Acute aortic dissection is a life-threatening condition associated with extremely high mortality. The presence of malperfusion in this patient cohort significantly increases mortality, with coronary malperfusion being among the most critical and dangerous forms. Despite the existing consensus on the management of Neri type A and type C coronary ostial dissections, the optimal treatment strategy for Neri type B dissections remains controversial, with advocates of immediate coronary artery bypass grafting as well as proponents of coronary ostial repair. The low incidence of such cases underscores the clinical relevance of this case report.

We present the case of a 58-year-old male who was admitted to our institution with a diagnosis of acute Stanford type A (DeBakey type II) aortic dissection hemodynamically stable. After admission to the intensive care unit, the patient suddenly developed signs of acute myocardial ischemia several hours later, manifested by electrocardiographic changes, elevated cardiac enzyme levels, and a reduction in left ventricular ejection fraction on echocardiography. Consequently, the patient was urgently transferred to the catheterization laboratory, where coronary angiography revealed a Neri type B dissection of the left coronary artery ostium with subtotal occlusion. Immediate surgical intervention-consisting of supracoronary replacement of the ascending aorta and the left coronary artery ostium repair -was performed directly following coronary angiography. In the postoperative period, follow-up coronary angiography confirmed the effectiveness of the repair. The patient was discharged in good clinical condition. A follow-up computed tomography scan was performed 8 months later.

Performing suture repair for LCA ostial dissection Type B according to Neri, with accompanying coronary malperfusion, may be a feasible option for correcting this pathology in selected cases. Timely diagnosis of myocardial ischemia and prompt surgical correction of aortic dissection can lead to satisfactory postoperative outcomes in these high-risk patients.

To determine the effectiveness of left coronary artery ostium repair in cases of its dissection (Type B according to Neri classification) with concomitant coronary malperfusion.