title: Acute myocardial infarction due to spontaneous, localized, acute dissection of the sinus of Valsalva detected by intravascular ultrasound and electrocardiogram-gated computed tomography.
abstract: A 58-year-old man was referred to our hospital because of chest pain. The 12-lead electrocardiogram (ECG) revealed ST-segment elevation in II, III, and a Vf with advanced heart block. Transthoracic echocardiography demonstrated aortic root dilatation at the sinus of Valsalva, moderate aortic regurgitation, and decreased wall motion in the inferior part of the left ventricle. Non-ECG-gated enhanced computed tomography (CT) did not reveal an aortic dissection. The patient underwent emergent coronary angiography, which revealed a severely narrowed ostium of the right coronary artery (RCA). Percutaneous coronary intervention (PCI) was performed under intravascular ultrasound (IVUS) guidance. IVUS images demonstrated an intimal flap extending from the aortic wall to the proximal RCA, suggesting that a periaortic hematoma in the false lumen compressed the ostium of the RCA, leading to acute myocardial infarction. To recover hemodynamic stability, the RCA ostium was stented. Subsequent ECG-gated enhanced CT clearly depicted the entry point and extension of the dissection localized within the sinus of Valsalva. The dissection likely involved the left main coronary artery and an emergent Bentall procedure was performed. Intraoperative findings confirmed an intimal tear and extension of the dissection. Thus, ECG-gated CT can clearly depict the entry site and extension of a dissection occurring in the localized area that cannot be detected by conventional CT.
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Ichihashi
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan. tuyosiito@gmail.com.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Murai
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Ikehara
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujita
authors.affiliation: Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Suda
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ohte
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; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation; D055424:Cardiac-Gated Imaging Techniques; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D011237:Predictive Value of Tests; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Aortic dissection; Coronary malperfusion; Electrocardiogram-gated computed tomography; Intravascular ultrasound