Stent-supported angioplasty of a residual coronary artery dissection following replacement of the ascending aorta for acute type A aortic dissection. A report of a successful case

A 54-year-old-man suddenly experienced severe back pain while eating. On admission to our hospital, contrast-enhanced computed tomography revealed an acute type A aortic dissection, and emergency surgical repair was performed the same day. Through median sternotomy, graft replacement of the ascending aorta, including removal of the site of the intimal tear, was carried out under deep hypothermia and retrograde cerebral perfusion. Although the postoperative course was satisfactory, the patient suddenly complained of sever chest pain on postoperative day 23; the ECG trace showed anomalous alterations. Emergency coronary angiography revealed the presence of a wide coronary artery dissection from the entry of the left anterior descending aorta (LAD) to the re-entry of the left circumflex artery (LCX). Multiple stents were implanted in the LAD and LCX. After stenting, the chest symptoms remitted and the ECG trace was normal. The patient was discharged from our hospital on postoperative day 42.

[Management of remaining coronary artery dissection after the replacement of the ascending aorta in acute type A aortic dissection]

The authors report a case study of a 54-year-old male admitted to our hospital with severe chest pain and ST depression in II, III and aVf lead on the electrocardiogram. The chest X-ray showed an enlarged superior mediastinum. An enhanced computed tomography (CT) was performed and confirmed the diagnosis of acute type A aortic dissection. The patient underwent emergency surgical repair with the replacement of the ascending aorta. The patient recovered without complication until the fifteenth postoperative day, when another severe chest pain appeared. Emergency coronary angiography revealed a remaining dissection in both the left anterior descending artery (LAD) and the left circumflex artery (LCx). Implantation of Elite stents to the LAD and the LCx was performed. The patient recovered uneventfully after this operation. Remaining coronary artery dissection after the replacement of the ascending aorta is very rare. In this case coronary intervention with Elite stents was effective.

[An operative case of congenital fistula of the right coronary artery to the left ventricle with congestive heart failure]

We reported an extremely rare case of congenital fistula of the right coronary artery to the left ventricle in a 71-year-old man who suffered from difficulty in breathing and palpitation. The diagnosis was confirmed by the right coronary angiography. The fistula was closed by Symbas's operation under cardiopulmonary bypass. Postoperative recovery was uneventful. Coronary angiography performed one year after the operation revealed that the right coronary artery was completely occluded by thrombus. But there were no signs of myocardial ischemia or infarction. And so we suspected that the dilated right coronary artery had not work as functional vessel.