Progressive coronary stenosis detected by intraoperative TEE after acute type-A aortic dissection repair: a case report.

IF 0.8 Q3 ANESTHESIOLOGY

JA Clinical Reports Pub Date : 2025-07-01 DOI:10.1186/s40981-025-00802-y

Asuka Komatsu, Hiroki Tateiwa, Kazumasa Orihashi, Takashi Kawano

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引用次数: 0

Abstract

Background: Acute type-A aortic dissection is a life-threatening condition requiring urgent intervention. Among its complications, coronary malperfusion is particularly fatal. Although rare, coronary artery stenosis after surgical repair is critical yet underrecognized.

Case presentation: A 77-year-old man underwent emergency aortic arch replacement for acute type-A aortic dissection. Intraoperative transesophageal echocardiography (TEE) initially showed no coronary involvement. However, ST-segment elevation and new hypokinesia appeared post-repair. TEE identified progressive left main coronary artery stenosis. Coronary angiography confirmed severe stenosis, leading to urgent coronary artery bypass grafting. The patient recovered well and was discharged on postoperative day 33.

Conclusions: This case highlights the importance of intraoperative TEE for early detection of coronary complications following acute type-A aortic dissection repair. Dissection can progress even after aortic replacement surgery and requires vigilance. Careful monitoring and prompt intervention are crucial to optimize the outcome of these rare but life-threatening events.

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急性a型主动脉夹层修复术后术中TEE检测进行性冠状动脉狭窄1例。

背景：急性a型主动脉夹层是一种危及生命的疾病，需要紧急干预。在其并发症中，冠状动脉灌注不良尤其致命。冠状动脉狭窄虽然罕见，但手术修复后的冠状动脉狭窄是至关重要的，但尚未得到充分认识。病例介绍：一名77岁男性因急性A型主动脉夹层接受紧急主动脉弓置换术。术中经食管超声心动图（TEE）最初未显示冠状动脉受累。然而，修复后出现st段抬高和新的运动功能减退。TEE诊断进行性左主干冠状动脉狭窄。冠状动脉造影证实严重狭窄，导致紧急冠状动脉旁路移植术。患者恢复良好，术后第33天出院。结论：本病例强调了术中TEE对急性a型主动脉夹层修复术后早期发现冠状动脉并发症的重要性。即使在主动脉置换手术后，夹层也可能继续发展，需要警惕。仔细监测和及时干预对于优化这些罕见但危及生命的事件的结果至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JA Clinical Reports ANESTHESIOLOGY-

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

9 weeks

期刊介绍： JA Clinical Reports is a companion journal to the Journal of Anesthesia (JA), the official journal of the Japanese Society of Anesthesiologists (JSA). This journal is an open access, peer-reviewed, online journal related to clinical anesthesia practices such as anesthesia management, pain management and intensive care. Case reports are very important articles from the viewpoint of education and the cultivation of scientific thinking in the field of anesthesia. However, submissions of anesthesia research and clinical reports from Japan are notably decreasing in major anesthesia journals. Therefore, the JSA has decided to launch a new journal, JA Clinical Reports, to encourage JSA members, particularly junior Japanese anesthesiologists, to publish papers in English language.