title: An uncommon presentation of acute type A aortic dissection:  left main coronary artery obstruction.
abstract: Acute aortic dissection presents with a wide range of manifestations. Sometimes an acute coronary syndrome is diagnosed instead of aortic dissection leading to inappropriate treatment. We describe a case of acute aortic dissection with the uncommon involvement of the left main coronary artery. A 64-year-old man was referred to our hospital for primary coronary intervention because ECG demonstrated ST elevation in the aVR lead with diffuse ST-segment depression. Coronary angiography was performed to treat the culprit lesion but the left main coronary artery could not be catheterized. Aortography and transesophageal echocardiography confirmed Stanford type A aortic dissection. The patient died of cardiac arrest in spite of cardiopulmonary resuscitation. This case also illustrates how Stanford type A aortic dissection can present with left main coronary artery obstruction.
authors.affiliation: Service de Cardiologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, Lyon Cedex 04, France. pycourand@hotmail.com
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Courand
authors.forename: Raphaël
authors.initials: R
authors.lastname: Dauphin
authors.forename: Eric
authors.initials: E
authors.lastname: Roussel
authors.forename: Cyril
authors.initials: C
authors.lastname: Besnard
authors.forename: Pierre
authors.initials: P
authors.lastname: Lantelme
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis; D001027:Aortography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D017809:Fatal Outcome; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests