Case Report: Intraoperative Open-Heart Coronary Angiography in Acute Type A Aortic Dissection

For patients with acute type A aortic dissection, strongly suspected of having concomitant severe coronary artery disease (CAD), preoperative or intraoperative coronary angiography has been recommended. However, conventional selective coronary angiography in this setting may extend the dissection or aortic rupture. We present the use of intraoperative open-heart coronary angiography in a patient with acute type A aortic dissection. A 50-year-old man presented with chest pain and dyspnea and was admitted to our department with acute type A aortic dissection. The patient underwent coronary artery stent implantation in the left anterior descending coronary artery (LAD) 3 years previously due to an acute myocardial infarction. This time we failed to evaluate the patency of the LAD using multidetector computed tomography. An aortic rupture occurred due to conventional coronary angiography, and open-heart coronary angiography was performed. The examination revealed no significant stenosis. A Bentall procedure and total aortic arch replacement were performed, with an intraoperative stent inserted into the descending aorta, and the patient had an uneventful postoperative course. From this case, we learn that intraoperative open-heart coronary angiography is safe and effective in patients with acute type A aortic dissection.

Download Full-text

Acute Type-A Aortic Dissection with Obstruction of the Right Coronary Artery

The Heart Surgery Forum ◽

10.1532/hsf98.2013246 ◽

2014 ◽

Vol 17 (4) ◽

pp. 196

Author(s):

Erhan Kaya ◽

Halit Yerebakan ◽

Daniel Spielman ◽

Omer Isik ◽

Cevat Yakut

Keyword(s):

Coronary Artery ◽

Aortic Dissection ◽

Right Coronary Artery ◽

Type A ◽

Sudden Onset ◽

Acute Type ◽

Type A Aortic Dissection ◽

Coronary Syndrome ◽

Bentall Procedure ◽

The Right

Occlusion of a coronary artery by an acute type A aortic dissection presents a life-threatening emergency that is rarely seen and easy to misdiagnose. We present the case of a 75-year-old male who experienced sudden onset of severe left-sided chest pain due to an acute type A aortic dissection that obstructed the right coronary artery. Following an initial misdiagnosis of acute coronary syndrome, imaging revealed the presence of an aortic dissection. An emergency modified Bentall procedure was performed, in which the damaged aorta and aortic valve were replaced.

Download Full-text

Complete avulsion of right coronary artery caused by acute type-A aortic dissection

Heart ◽

10.1136/heartjnl-2013-304066 ◽

2013 ◽

Vol 99 (21) ◽

pp. 1628-1628 ◽

Cited By ~ 2

Author(s):

Amit Modi ◽

Paul Diprose ◽

Geoffrey Tsang

Keyword(s):

Coronary Artery ◽

Aortic Dissection ◽

Right Coronary Artery ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

Download Full-text

Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezt060 ◽

2013 ◽

Vol 44 (3) ◽

pp. 419-425 ◽

Cited By ~ 36

Author(s):

K. Imoto ◽

K. Uchida ◽

N. Karube ◽

T. Yasutsune ◽

T. Cho ◽

...

Keyword(s):

Coronary Artery ◽

Risk Analysis ◽

Aortic Dissection ◽

Type A ◽

Artery Dissection ◽

Acute Type ◽

Coronary Artery Dissection ◽

Type A Aortic Dissection

Download Full-text

The “High Take-Off” Left Main Coronary Artery in a Patient With Acute Type A Aortic Dissection

Circulation ◽

10.1161/circulationaha.113.008395 ◽

2014 ◽

Vol 130 (12) ◽

Cited By ~ 1

Author(s):

Woon Heo ◽

Ho-ki Min ◽

Do Kyun Kang ◽

Hee Jae Jun ◽

Youn-Ho Hwang ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Dissection ◽

Left Main Coronary Artery ◽

Type A ◽

Acute Type ◽

Left Main ◽

Type A Aortic Dissection

Download Full-text

A Case of Late Acute Type A Aortic Dissection after Coronary Artery Bypass Grafting

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.39.273 ◽

2010 ◽

Vol 39 (5) ◽

pp. 273-275 ◽

Cited By ~ 1

Author(s):

Kengo Nishimura ◽

Shigeto Miyasaka ◽

Keisuke Morimoto ◽

Iwao Taniguchi

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Aortic Dissection ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Type A ◽

Acute Type ◽

Bypass Grafting ◽

Type A Aortic Dissection ◽

Artery Bypass Grafting

Download Full-text

A Case of an Acute Type A Aortic Dissection with Left Coronary Artery Malperfusion that was Successfully Stented as a Bridge to Surgery

Journal of Coronary Artery Disease ◽

10.7793/jcad.27.20-00013 ◽

2021 ◽

Vol 27 (2) ◽

pp. 68-71

Author(s):

Tatsuya Shigematsu ◽

Hideki Okayama ◽

Shinsuke Kido ◽

Kenshou Matsuda ◽

Tetsuya Aono ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Dissection ◽

Left Coronary Artery ◽

Type A ◽

Acute Type ◽

Bridge To Surgery ◽

Type A Aortic Dissection

Download Full-text

Abstract 17497: Management of Acute Type A Aortic Dissection in an Hybrid Operating Room: - Feasibility and Added Value of Preoperative Angiography and Intravascular Ultrasound

Circulation ◽

10.1161/circ.132.suppl_3.17497 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Rolf A Janosi ◽

Konstantinos Tsagakis ◽

Philipp Kahlert ◽

Eva Kottenberg ◽

Riccardo Gorla ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Dissection ◽

Operating Room ◽

Intravascular Ultrasound ◽

Type A ◽

Time Interval ◽

Acute Type ◽

Hybrid Operating Room ◽

Type A Aortic Dissection ◽

The Impact

Introduction: Acute type A aortic dissection (ATAAD) is rapidly lethal and requires comprehensive tactics and decision making. To refine our respective approach we retrospectively analyzed our patients undergoing urgent surgery in our hybrid operating room over a 10 year period for the impact of immediate preoperative coronary angiography (CA), aortography, and/or intravascular ultrasound (IVUS) for the detection of coronary artery disease (CAD) and/or arterial malperfusion. Methods: 136 patients (mean age: 60.6 y ± 13; 63% male, March 2004-February 2014) underwent preoperative CA with or without IVUS. We assessed the time interval from preoperative CA to surgery and the impact for concomitant coronary artery bypass grafting (CABG) or endovascular interventions. Results: The delay to proceed with surgery due to preoperative catheterization averaged 32 min ± 26 (Fig. 1) in the setting of the hybrid OR. CA revealed CAD in 47/136 (35%) patients, with CABG consequently performed in 38 (28%). In 12 (9%) patients, CABG was necessary due to ostium obstruction by the dissection. 30-day mortality more than doubled in patients with concomitant CAD (27.7% vs. 11.2%, respectively, p<0.01). However in patients with confirmed CAD, mortality was less 19% (6/31), in those undergoing CABG, compared to 44% (7/16) for isolated aortic repair (p=0.08). Conclusions: In a hybrid operating room setting, preoperative coronary and aortic angiography do not unduly delay surgery, facilitate diagnosis of coronary malperfusion, and allowing concomitant CABG in as much as 28% of patients.

Download Full-text

Aortic root remodelling with external ring annuloplasty in acute type A aortic dissection

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz227 ◽

2019 ◽

Vol 30 (1) ◽

pp. 85-90 ◽

Cited By ~ 2

Author(s):

Yasuyuki Kato ◽

Kenichi Sasaki ◽

Hidetaka Yamauchi ◽

Yasuyuki Kanno ◽

Taiyo Jinno ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Aortic Dissection ◽

Aortic Regurgitation ◽

Aortic Root ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

External Ring ◽

Ring Annuloplasty

Abstract OBJECTIVES To investigate the early and mid-term results of aortic root remodelling with external ring annuloplasty in acute type A aortic dissection. METHODS From January 2015 to April 2019, a total of 194 patients underwent emergency or urgent operation for acute type A aortic dissection in our hospital. Of these, outcomes in 18 patients who underwent valve-sparing aortic root remodelling with external ring annuloplasty were retrospectively evaluated. RESULTS The mean age of the 18 patients was 49 ± 14 years. Fourteen patients (78%) were men. Five patients had Marfan syndrome and 2 patients had bicuspid aortic valve. Two patients had coronary malperfusion and 1 patient had cerebral malperfusion. All 18 patients underwent aortic root remodelling with external ring annuloplasty. Cusp repair using central cusp plication was required in 9 patients. Concomitant procedures were hemiarch replacement in 8 patients, total arch replacement in 7 patients, partial arch replacement in 1 patient and coronary artery bypass grafting to the right coronary artery in 3 patients. Thirty-day mortality rate was 5.6% (1 of 18). Postoperative echocardiography showed aortic regurgitation of <1+ in all patients. During follow-up (mean 56 ± 41 months), 1 case of recurrent aortic regurgitation required aortic valve replacement. CONCLUSIONS Aortic root remodelling with external ring annuloplasty may be an appropriate treatment in middle-aged or younger patients presenting with acute type A aortic dissection.

Download Full-text