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Chirurgia 2006 June;19(3):193-9

language: English

Acute coronary involvement due to acute Type A aortic dissection

Lin C.-C., Lee C.-S., Chen Y.-F., Pan P.-C., Chen H.-M., Hsieh C.-C., Huang J.-W., Yon H.-W., Hwang Y.- S.

Division of Cardiology, and Cardiovascular Surgery and School of Public Health Kaohsiung Medical University Hospital, Kaohsiung, Taiwan


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Aim. There is scanty information being published based on acute coronary involvement due to acute type A aortic dissection. The purpose of this study was to examine our contemporary experience of a selected group of seven patients with coronary acute involvement due to acute type A aortic dissection which evolved over a 7-year period with 50 consecutive acute type A aortic dissection.
Methods. Between 1997 and 2004, seven patients (14.0%) from a total 50 patients underwent surgical repair of acute coronary involvement due to acute type A aortic dissection. There were 5 men and 2 women whose ages ranged from 36 to 59 years with a mean age of 48.1±7.5 years. The right coronary artery was involved in 5 patients, and left in 2 patients. Two patients had acute myocardial infarction due to coronary malperfusion preoperatively, and another three patients suffered myoischemia before surgery. Two patients had no evidence of myocardial ischemia preoperatively although acute coronary involvement was noted.
Results. The hospital mortality rate was 28.6% (2 of 7). Mechanisms of acute coronary involvement were compression (2 patients), ostial intimal tear (1 patient), and total detachment of coronary ostium (4 patients). After a mean follow-up time of 50.6±16.8 months, the actuarial survival rates were all 71.43±2.78% at 1, and 4 years.
Conclusions. Acute coronary involvement due to acute type A aortic dissection is not necessary denoted coronary malperfusion. Nevertheless, immediate aortic reconstruction and coronary revascularization is mandatory in order to improve survival for this complex cohort of patients.

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