A Surgical Case of Acute Type A Aortic Dissection with Right Coronary Malperfusion and Paraplegia

Abstract

Both coronary malperfusion and paraplegia are fatal complications of type A aortic dissection. We report a rare case of successful surgical repair for type A aortic dissection simultaneously complicated with both right coronary malperfusion and paraplegia. A 44-year-old man was admitted to our hospital with sudden chest and back pain. ST elevation and atrioventricular block were shown in an electrocardiogram. The echocardiogram demonstrated asynergy of left ventricular wall motion in the inferior and posterior area. Enhanced computed tomography revealed type A aortic dissection with right coronary malperfusion. We performed emergent repair of the ascending aorta and aortic arch without implantation of a coronary stent prior to the surgical repair. After the operation, satisfactory right coronary revascularization was obtained. However, after the patient woke up from anesthesia, paraplegia was recognized. The paraplegia was successfully treated with acute administration of naloxone, acute cerebrospinal fluid drainage and subacute administration of a large dose of methylprednisolone. He was discharged without any neurologic deficits on the 49 th postoperative day.