Acute Type A Aortic Dissection Involving Malperfusion of Bilateral Coronary Arteries

The outcomes of AAD have improved over the years because of the establishment of a diagnostic technology and advancements in surgical treatment techniques. However, acute myocardial ischemia associated with aortic dissection is relatively rare and results in a critical condition of the patient -. Although a definite method for treating an infarcted myocardium due to acute aortic dissection has not yet been established, it is extremely important to restore coronary circulation immediately -. The effectiveness of the preoperative placement of a perfusion catheter or a coronary artery stent into the ischemic coronary artery has been demonstrated. However, it is particularly difficult to recognize coronary malperfusion because the patient’s hemodynamics is often unstable and there is no sufficient time to assess the patient thoroughly. Adequate assessment becomes more difficult if the malperfusion involves the bilateral coronary arteries -. 1. Case report 1 The first case was a 44-year-old man who suffered from loss of consciousness and cardiogenic shock upon arrival. The patient was transferred to a catheterization laboratory directly as acute coronary syndrome was suspected because of the ischemic changes shown on electrocardiography. Intra-aortic balloon pumping and percutaneous cardiopulmonary support were initially established, and aortography showed ascending aortic dissection (Fig. 1a), thus we were consulted as cardiologists. CAG revealed severe stenosis of the left main coronary artery (Fig. 1b) and detachment of the right coronary artery orifice. As the blood flows of the bilateral coronary arteries were extremely slow, stent implantation into the left main trunk and guidewire insertion into the right coronary artery (Fig. 1c) were performed immediately. The patient’s hemodynamics stabilized after this treatment and then he was transferred to an operation room to undergo emergency surgical treatment. CT scan was not performed because of the obvious AAD on aortography (Fig. 1a). Transesophageal echocardiography (TEE) performed during general anesthesia Case Report