Mechanism of coronary malperfusion due to type-a aortic dissection.

摘要

A 44-year-old man was admitted to a community hospital with acute onset of chest pain. Based on ECG findings and a mild troponin elevation, the patient was initially treated for acute coronary syndrome. On the 2nd day of hospitalization, troponin increased to 12 ng/ml and transthoracic echocardiography showed severe aortic regurgita-tion, so that computed tomography was performed and revealed Stanford type-A aortic dissection of the ascending aorta. The patient was immediately transferred to the hybrid operating room of our hospital. Preoperative coronary angiography showed non-stenotic coronary heart disease. Intraoperative trans-esophageal echocardiography revealed an intimal flap beginning just above the aortic valve. During diastole, the intimal flap prolapsed through the aortic valve, resulting in intermittent diastolic occlusion of the coronary ostia (Figure 1). Emergency operation resulted in successful replacement of the ascending aorta and reconstruction of the aortic valve.