Abstract
Background: Emergency surgery is usually selected for patients with Stanford A aortic dissection. However, operative indication is still controversial in thrombosed-type Stanford A aortic dissection especially in highly-aged patients or in patients with multiple complications.
Material and Method: Ischemic changes in electrocardiogram (ECG) just after the onset of type A dissection were retrospectively evaluated. Twenty-four patients with the mean age of 67 years were included. The mean maximum short-axis diameter of ascending aorta was 45±21 (30-53) mm.
Results: Ischemic ECG changes were observed in 13 (54%) patients. A ST-elevation on the chest leads was detected in five patients and that on the limb leads in three patients. A ST-depression was observed in a case and inverted T in four. Eleven patients underwent emergency operation and 13 patients were treated medically. Out of 11 patients who were absent from ischemic ECG changes, five patients with aortic dilatation of 45 mm or larger underwent surgery and six patients received conservative treatments. In 13 patients with ischemic ECG changes, six patients underwent surgery and residual seven patients received conservative treatments. The entry of aortic dissection was intraoperatively detected at ascending or arch aorta in four patients including three patients with a ST-elevation on the chest leads. In these three patients with a ST-elevation on the chest leads, extensive dissection including bilateral coronary artery orifices was detected. Twenty three patients survived and a patient with a ST-elevation on the chest leads died of bowel ischemia during conservative treatment. Creatinine phosphokinase (CPK) values on the hospital arrival were 2,425±1,576 IU/l in patients with ST elevation on chest leads, which was significantly (p<0.05) higher than 109±18 IU/l in patients without ischemic ECG change. ST-elevation on chest leads disappeared on the day of onset or after surgery, however, old myocardial infarction occurred in two patients even in late periods.
Discussion: In thrombosed-type Stanford A aortic dissection, a ST-elevation was transient probably because the compression on the coronary artery decreased by the progression of thrombosis in the false lumen. However, a ST-elevation on the chest leads indicates the compression on the left main trunk.
Conclusion: Patients with ST-elevation on chest leads should be operated urgently. Patients with other ischemic ECG changes may be observed conservatively except for large ascending aortic dilatation.
