title: [Myocardial Ischemia in Acute Type A Aortic Dissection; Coronary Artery Dissection and Functional Ischemia].
abstract: Myocardial ischemia due to acute type A dissection is a fatal complication. This study was undertaken to evaluate the surgical results of acute type A aortic dissection with myocardial ischemia. Between 1986 and 2014, 364 patients were treated for acute type A dissection in our hospital. Twenty-four patients were underwent myocardial revascularization. Preoperative coronary artery stent placement was involved in 2, coronary-artery bypass grafting (CABG) 18 (right 12, left 4, both 2), reCABG 2, and Carrel patch with coronary orifice restoration 2. Seven of CABG group had no symptom of myocardial ischemia, but right coronary artery was circumferentially detached from the intimal ostia. Hospital mortality was 20.1% in patients who underwent CABG. Sixteen patients with significant electrocardiogram ischemic change were not undertaken with CABG, because coronary artery was not involved by dissection. In these cases, acute aortic valve regurgitation, loss of backward pressure from distal aorta, or valve formation by intimal tear in ascending aorta might decrease diastolic pressure at aortic root and make myocardial ischemia.
authors.affiliation: Department of Cardiovascular Surgery, shizuoka Municipal Hospital, Shizuoka, Japan.
authors.forename: Masanao
authors.initials: M
authors.lastname: Nakai
authors.forename: Fumio
authors.initials: F
authors.lastname: Yamasaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mitsuoka
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Miura
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Terai
authors.forename: Shinnosuke
authors.initials: S
authors.lastname: Goto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Mizuno
authors.forename: Yuta
authors.initials: Y
authors.lastname: Miyano
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Shinji
authors.initials: S
authors.lastname: Kawaguchi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology* / Q000601:surgery; D009204:Myocardial Revascularization; D015607:Stents