Percutaneous coronary intervention is a useful bridge treatment for acute myocardial infarction due to acute type A aort
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CASE REPORT
Percutaneous coronary intervention is a useful bridge treatment for acute myocardial infarction due to acute type A aortic dissection Satoshi Kodera • Masayuki Ikeda • Kazutoshi Sato Syunichi Kushida • Junji Kanda
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Received: 11 March 2013 / Accepted: 31 January 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract We report a 71-year-old woman with inferior acute myocardial infarction (AMI) due to type A acute aortic dissection. Emergency enhanced computed tomography (CT) did not show obvious aortic dissection. During emergency percutaneous coronary intervention (PCI), intravascular ultrasonography revealed type A aortic dissection. Hemodynamic stability was restored after PCI. 1 month later, CT revealed a sinus of Valsalva aneurysm, which was treated surgically. This case suggests that PCI could be a good initial treatment option for unstable patients with AMI due to type A aortic dissection. This is the first reported case of sinus of Valsalva aneurysm subsequent to aortic dissection.
emergency surgery [4]. However, diagnosis is difficult in some cases [5], and the surgery may be difficult to perform. Some patients are so unstable that they cannot wait for surgery; for these patients percutaneous coronary intervention (PCI) is useful. There are several reports of patients with AMI due to type A aortic dissection who were successfully treated with PCI [6–15]. We report a case of AMI due to type A aortic dissection that was successfully treated with PCI in an emergency situation. The patient underwent surgery 1 month later for a sinus of Valsalva aneurysm.
Keywords Percutaneous coronary intervention Aneurysm Inferior acute myocardial infarction Acute aortic dissection
Our patient was a 71-year-old woman with a history of type A acute aortic dissection in 2006. That dissection had extended from the root of the aorta to the celiac artery and was of thrombosed type with a small ulcer-like projection of the ascending aorta 2.5 cm distal to the right coronary artery (RCA) ostium. There had been some pericardial effusion and aortic regurgitation but no tamponade nor coronary involvement. She had been treated medically because she was hemodynamically stable, with no evidence of malperfusion and no residual false lumen. In 2010, echocardiography showed mild dilation of the ascending aorta (45 mm) and moderate aortic regurgitation. She was asymptomatic until the morning of admission in May 2011, when she attended our hospital for a periodic medical checkup for hypertension. When she was waiting in the outpatient clinic, she complained of sudden chest discomfort and gradually lost consciousness. She was immediately transferred to the emergency department. On arrival there, her systolic blood pressure was 70 mmHg, her heart rate 30 beats/min, and she had regained consciousness. Examination revealed a grade III/VI diastolic heart murmur in the second intercostal space
Introduction Type A aortic dissection is associated with a 7–13 % incidence of retrograde dissecti
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