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. 2025 Jul 1;11(1):38.
doi: 10.1186/s40981-025-00802-y.

Progressive coronary stenosis detected by intraoperative TEE after acute type-A aortic dissection repair: a case report

Asuka Komatsu  1 , Hiroki Tateiwa  2 , Kazumasa Orihashi  2 , Takashi Kawano  2
Affiliations

Progressive coronary stenosis detected by intraoperative TEE after acute type-A aortic dissection repair: a case report

Asuka Komatsu et al. JA Clin Rep. .

Abstract

Background: Acute type-A aortic dissection is a life-threatening condition requiring urgent intervention. Among its complications, coronary malperfusion is particularly fatal. Although rare, coronary artery stenosis after surgical repair is critical yet underrecognized.

Case presentation: A 77-year-old man underwent emergency aortic arch replacement for acute type-A aortic dissection. Intraoperative transesophageal echocardiography (TEE) initially showed no coronary involvement. However, ST-segment elevation and new hypokinesia appeared post-repair. TEE identified progressive left main coronary artery stenosis. Coronary angiography confirmed severe stenosis, leading to urgent coronary artery bypass grafting. The patient recovered well and was discharged on postoperative day 33.

Conclusions: This case highlights the importance of intraoperative TEE for early detection of coronary complications following acute type-A aortic dissection repair. Dissection can progress even after aortic replacement surgery and requires vigilance. Careful monitoring and prompt intervention are crucial to optimize the outcome of these rare but life-threatening events.

Keywords: Acute type-A aortic dissection; Coronary artery stenosis; Transesophageal echocardiography.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from the patient for publication of this case report. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Electrocardiography. a Admission electrocardiogram demonstrating no significant abnormalities or ischemic changes. b After cardiopulmonary bypass, ST-segment elevation in lead aVR. c Coronary angiogram of the left coronary artery, demonstrating occlusion of the left main trunk (arrow)
Fig. 2
Fig. 2
Temporal changes in electrocardiography monitoring and transesophageal echocardiography. a Pre CPB, partial calcification was observed at the ostium of the left main trunk (LMT). b One hour after CPB, only findings of LMT dissection are observed. c Two hours after CPB, ST-segment depression appearing on ECG. d Pre CAG, the stenotic ratio reaching nearly 90%
Fig. 3
Fig. 3
Computed tomography. a Preoperative and b postoperative left main trunk (LMT) (*). The dissection of the LMT has resolved
See this image and copyright information in PMC

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