Abstract
We report two surgical cases of acute aortic dissection of Stanford type A followed by coronary ostium dissection with Marfan's syndrome.
The first case was a 45-year-old female with Marfan's syndrome associated with annulo-aortic ectasia who had been treated with antihypertensive agent for acute type A dissection in ICU. The ECG change of ST elevation in leads II, III and aVf indicated that aortic dissection spreaded to the right coronary ostium. Emergent aortic root replacement, right coronary artery bypass grafting (CABG) with saphenous vein and left coronary ostium reconstruction with Piehler procedure were performed.
The second case, a 45-year-old female with Marfan's syndrome associated with annulo-aortic ectasia, revealed acute type A dissection with severe aortic regurgitation. Right coronary ostium dissection was found intraoperatively, and aortic root replacement, right CABG with saphenous vein and left coronary ostium reconstruction with Bentall procedure were performed. Both patients were discharged without postoperative myocardial infarction.
Aortic root reconstruction and complete coronary reconstruction including CABG are necessary to avoid myocardial infarction in case that acute type A dissection spread to the coronary ostium.
