[Treatment of acute type A aortic dissection with onset of the right coronary insufficiency]

Abstract

This is a case report of the successful treatment for acute type A aortic dissection with onset of the right coronary artery (RCA) obstruction due to compression of the dissected lumen. A 50-year-old man, who had been received medical therapy for hypertension for seven years, was admitted with profound cardiogenic shock. The ECG demonstrated complete A-V block and acute myocardial infarction (AMI) of right ventricle and inferior wall. Coronary catheter intervention was scheduled because intra-aortic balloon pumping was not effective, and arteriogram revealed aortic dissection, coronary insufficiency and aortic regurgitation (grade I). Soon after inflation of a perfusion catheter at the origin of RCA, elevation of arterial blood pressure and recovery to sinus rhythm were brought successfully by the coronary reperefusion. Replacement of the ascending aorta involving the intimal tear without surgical closure of RCA ostium, aortic valve resuspension and coronary artery bypass grafting with saphenous vein to RCA were performed 11 hours after the onset, and the postoperative course was uneventful. Although aortic dissection with onset of AMI was uncommon, it is suspected that the generalizing of catheter intervention for AMI increases awareness of such cases and it is emphasised that the application of perfusion catheter as an emergency procedure for the illness like this case is useful to preserve hemodinamic stability until the surgical treatment.