title: [Transesophageal Echocardiography Was Useful to Determine a Therapeutic Strategy for Coronary Artery Ischemia during Surgery for Acute Type A Aortic Dissection: A Case Report].
abstract: A 57-year-old woman presented with acute back pain, diagnosed with acute type A aortic dissection, and we performed emergency ascending aortic replacement. During surgery, until cardiopulmonary bypass was started, the dissection did not extend to the orifice of the both coronary arteries. When aortic replacement was completed and just after the return of spontaneous beating, ventricular fibrillation (Vf) suddenly occurred. At that time, transesophageal echocardiography (TEE) revealed that dissection extended from the left main trunk (LMT) to the left circumflex artery (LCX). Recurrent Vf and circulatory collapse necessitated the application of a percutaneous cardiopulmonary support system (PCPS), while the surgeons performed cardiac massage. Additional emergency coronary artery bypass surgery (CABG) was immediately implemented. After the CABG, TEE showed that the true lumens of the LMT and LCX were dilated, allowing an increased flow to the LAD and LCX. The patient was discharged 2 months later. Although rare, coronary ischemia can be a complication of acute aortic dissection, resulting in decreased survival. Development of dissection to the coronary artery can also occur both intra- and postoperatively. In such instances, rapid diagnosis and treatment are important to save the patient.
authors.forename: Saori
authors.initials: S
authors.lastname: Takahashi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Gamo
authors.forename: Yuko
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kawana
mesh_terms: D001011:Aorta / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery*