Coronary malperfusion in acute type A aortic dissection

Coronary malperfusion in acute type A aortic dissection

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To the Editor, Coronary malperfusion in patients with aortic dissection further worsens prognosis due to compromised myocardial blood flow.The incidence rate of coronary disease goes from 9% to 10% according to various registries.1,2 Also, it can occur simultaneously at the beginning of dissection, during the patient transfer or in the middle of surgery.The management of these patients is still a matter of discussion.The optimal time of oceane eau de toilette myocardial reperfusion is 90 min, a timeframe that cannot be guaranteed with surgical revascularization associated with aortic valve repair surgery.

This is the case of a 65-year-old man.The patient was a smoker with chronic kidney disease pitkin and mother gaston who was admitted to our center as a «myocardial infarction code» case due to suspected anterior ST-segment elevation acute coronary syndrome.The coronary angiography revealed the presence of a type A aortic dissection with coronary malperfusion due to left main coronary artery (LMCA) occlusion.The patient had reported to his tertiary referral center with a 30-min history of oppressive retrosternal chest pain.Upon arrival at the emergency room, he remained symptomatic and hemodynamically unstable (pale, sweaty, low arterial blood pressure levels, 60/40 mmHg).

The electrocardiogram showed anterior ST-segment elevation and aVR changes, which is why the «myocardial.