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Case Reports
. 2018 Dec 20;24(6):320-323.
doi: 10.5761/atcs.cr.17-00140. Epub 2018 Jan 30.

Direct Repair of Localized Aortic Dissection with Critical Malperfusion of the Left Main Trunk

Toshiki Fujiyoshi  1 , Nobusato Koizumi  1 , Toshiya Nishibe  1 , Kayo Sugiyama  1 , Hitoshi Ogino  1
Affiliations
Case Reports

Direct Repair of Localized Aortic Dissection with Critical Malperfusion of the Left Main Trunk

Toshiki Fujiyoshi et al. Ann Thorac Cardiovasc Surg. .

Abstract

Background: Localized aortic dissection on the left coronary cusp with critical malperfusion of the left main trunk (LMT) is rare and carries a high risk of death.

Case presentation: We report a case of a 48-year-old patient who developed localized aortic dissection of the left coronary cusp complicated by critical malperfusion of the LMT of the coronary artery. After percutaneous coronary intervention (PCI) for the LMT, a Koster-Collins-like direct repair of the localized aortic dissection was carried out by closure of the false channel using BioGlue (CyroLife, Inc., Kennesaw, GA, USA) with the reinforcement of double Teflon felt strips.

Conclusion: The aortic repair using a modified Koster-Collins technique was successful.

Keywords: direct repair; localized aortic dissection; malperfusion of left main trunk.

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Figures

Fig. 1
Fig. 1. Coronary angiography and IVUS images. (A) Angiography showed severe stenosis at the site of the LMT. (B) IVUS images revealed the dissection flap (dotted lines) and visualized a hematoma from the aorta to throughout the length of the LMT. IVUS: intravascular ultrasound; LMT: left main trunk
Fig. 2
Fig. 2. (A) Transesophageal echocardiography images. A hematoma (star sign) was detected from the left coronary cusp. (B) Intraoperative findings revealed a longitudinal intimal tear without a mobile intimal flap and a dissection 15 mm in length in the posterolateral wall of the left coronary cusp with a coronary false channel and implanted coronary stent.
Fig. 3
Fig. 3. Contrast-enhanced computed tomography images. Postoperative contrast-enhanced computed tomography showed no extension of the aortic dissection, obliteration of the false channel, and patency of the coronary stents and bypass grafts.
See this image and copyright information in PMC

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