title: Coronary malperfusion due to flap suffocation after acute type A dissection surgery.
abstract: A 24-year-old man presented with chest pain. He was diagnosed as having a type A acute aortic dissection and an annulo-aortic aneurysm. After emergency surgery for an aortic root replacement, his electrocardiogram showed ST-segment depression and T-wave inversion. Echocardiography showed asynergy of the left ventricle without coronary ostial pathology. Heart catheterization revealed no coronary stenosis, but the true lumen of the residual ascending aorta had extreme diastolic narrowing due to flap suffocation. This resulted in coronary malperfusion. The pullback pressure curve confirmed the mechanism. The patient underwent a surgical re-intervention for a total arch repair, which diminished the coronary malperfusion. At a follow-up appointment four years and four months later, the patient was doing well.
authors: Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Saitamam, Japan. isodas@ndmc.ac.jp
authors: Susumu
authors: S
authors: Isoda
authors: Motohiko
authors: M
authors: Osako
authors: Tamizo
authors: T
authors: Kimura
authors: Yuji
authors: Y
authors: Mashiko
authors: Nozomu
authors: N
authors: Yamanaka
authors: Shingo
authors: S
authors: Nakamura
authors: Tadaaki
authors: T
authors: Maehara
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization; D003326:Coronary Circulation; D003327:Coronary Disease / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult