Abstract
Acute myocardial infarction due to retrograde dissection of the aortic root reaching the coronary ostia is a potentially fatal condition. A 68-year-old man with a history of hypertension was hospitalized with sudden onset of chest pain and compression. He was admitted with cardiogenic shock with a systolic pressure of 70 mmHg under dopamine infusion. His electrocardiogram (ECG) demonstrated ST elevation in II, III and aVF leads and complete A-V block. Enhanced computed tomography showed a type A acute aortic dissection. These data strongly suggested malperfusion of right coronary artery. During preparation for emergency operation, catheter intervention was performed immediately. The coronary angiogram showed a 99% stenosis in segment 1-2. Stents were implanted in the right coronary artery to restore coronary blood flow. After stenting, his hemodynamic state became stable and chest symptoms was diminished. Then he underwent total arch replacement including the ascending aorta and coronary arterial bypass grafting using a saphenous vein graft. He suffered a cerebral infarction, but he was given an ambulatory discharged without any neurologic deficits on the 48th postoperative day. A bridge use of stents is considered useful to preserve hemodynamic stability until surgical treatment.
