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J Thorac Cardiovasc Surg 2003;125:1548-1550
© 2003 The American Association for Thoracic Surgery

Brief Communications

Flap suffocation: An uncommon mechanism of coronary malperfusion in acute type A dissection

From the Thoracic and Cardiovascular Surgery Department, University Hospital of Caen, France,^a and the Vascular Surgery Department, University Hospital of Siena, Italy.^b

Received for publication Aug 10, 2002. Accepted for publication Sept 9, 2002. Address for reprints: Massimo Massetti, MD, Thoracic and Cardiovascular Surgery Department, University Hospital, 14033, Caen, France (E-mail: massetti-m@chu-caen.fr).

The first 20% of the full text of this article appears below.

Acute myocardial ischemia or infarction as a result of retrograde coronary artery dissection is a well-known complication after acute type A aortic dissection. ¹ Although the prevalence of chronic coronary artery disease among patients with acute dissection of the ascending aorta has been reported to be between 8% and 41%, ² retrograde dissection of the aortic root reaching the coronary ostia is the most typical cause of acute coronary malperfusion observed in this condition. ¹ However, other mechanisms of myocardial ischemia, related to the diastolic expansion of the false aortic channel, have been described by Borst. ³

We present here the case of a patient with acute type A aortic dissection in whom an acute coronary malperfusion was sustained by an atypical mechanism of flow obstruction.

Clinical summary

A 49-year-old man with a history of hypertension and sarcoidosis was transferred from an outlying hospital to our institution in severe cardiogenic shock. Two hours previously, he had experienced the sudden onset of acute chest pain, followed within a few minutes by shortness of breath and severe hypotension. A 12-lead electrocardiogram showed diffuse ST-segment depression and T-wave inversion with an anterior ST elevation (without a related Q wave). A transthoracic echocardiogram was not of diagnostic quality because of . . . [Full Text of this Article]

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