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Case Reports
. 2025 Aug 27;30(25):104800.
doi: 10.1016/j.jaccas.2025.104800.

Inferior ST-Segment Elevation Myocardial Infarction Due to Extrinsic Compression Caused by an Aortic False Aneurysm

Victor Lacoste  1 , Sébastien Levesque  2 , Valentin Patouiller  2 , Mélina Combeau  3 , Géraldine Allain  4 , Clément Colombier  4 , Arthur Ramonatxo  2
Affiliations
Case Reports

Inferior ST-Segment Elevation Myocardial Infarction Due to Extrinsic Compression Caused by an Aortic False Aneurysm

Victor Lacoste et al. JACC Case Rep. .

Abstract

Background: A 50-year-old woman with a 2-month history of mechanical Bentall surgery for a type A dissection was admitted to the cardiology department because of an inferior ST-segment elevation myocardial infarction.

Case summary: In the presence of atypical chest pain and the discovery of pericardial and pleural effusion, no P2Y12 receptor inhibitor or anticoagulation was administered before the coronary angiography. It revealed diffuse atypical stenosis, and optical coherence tomography showed an oval-shaped artery with no plaque rupture, hematoma, or erosion. Computed tomography scan identified a compressive false aneurysm at the distal Bentall suture, which was surgically repaired by cardiac surgeons. The control angiogram then revealed a subnormal right coronary artery.

Discussion and take-home messages: This case highlights the recent guidelines from the European Society of Cardiology, which support the utility of intracoronary imaging and qualify the systematic use of P2Y12 inhibitors before the angiogram, even in ST-segment elevation myocardial infarction.

Keywords: Bentall; OCT; STEMI; dissection.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Admission Electrocardiogram Initial electrocardiogram showing an inferior ST-segment elevation myocardial infarction (red arrows) accompanied by an anterolateral mirror pattern (blue arrows).
Figure 2
Figure 2
Preoperative Right Coronary Angiogram
Figure 3
Figure 3
Preoperative Intracoronary Optical Coherence Tomography
Figure 4
Figure 4
Preoperative Computed Tomography Scan (A) Contrast-enhanced hematoma on the right anterior surface of the heart (red star). (B) Inferior hematoma (green star), right coronary (red arrow), and contrast-enhanced hematoma (red star). (C) Distal anastomosis (orange arrow), contrast-enhanced hematoma (red star), and inferior hematoma (green star). (D) Compression of the RA, RV, and right coronary artery (red arrow); contrast-enhanced hematoma (red star); and inferior hematoma (green star). RA = right atrium; RV = right ventricle.
Figure 5
Figure 5
Postoperative Right Coronary Angiogram
Figure 6
Figure 6
Angiogram and Optical Coherence Tomography Findings (A) Preoperative angiogram findings. (B) Postoperative optical coherence tomography findings. (C) Preoperative angiogram findings. (D) Postoperative optical coherence tomography findings.
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References

    1. Boccalini S., Swart L.E., Bekkers J.A., et al. CT angiography for depiction of complications after the Bentall procedure. Br J Radiol. 2019;92(1093) doi: 10.1259/bjr.20180226. - DOI - PMC - PubMed
    1. Rao S., O’Donoghue M., Ruel M., et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2025;85(22):2135–2237. doi: 10.1016/j.jacc.2024.11.009. - DOI - PubMed
    1. Byrne R.A., Rossello X., Coughlan J.J., et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44 doi: 10.1093/eurheartj/ehad191. - DOI - PubMed

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