A Complete Occlusion of Right Coronary Artery Due to Stanford Type A Aortic Dissection - Successful Treatment with Extracorporeal Membrane Oxygenation (ECMO)

Abstract

We present a patient diagnosed Stanford Type A aortic dissection, who was misdiagnosed as acute myocardial infarction for 5 days. In the surgery, the right coronary ostium was totally occluded, and the right coronary artery (RCA) was bluish from the trunk to branches. The true lumen couldn’t be found when we opened the RCA. We had to give up coronary artery bypass grafting (CABG). After a regular surgery of type A aortic dissection, the patient was failed to wean from cardiopulmonary bypass due to the right heart dysfunction. The Extracorporeal membrane oxygenation (ECMO) was instituted. The right ventricular wall motion was gradually improved during the post-operation period. This is the first report of using ECMO to successfully treat a complete occlusion of the right coronary artery due to a Type A aortic dissection. This case demonstrates the value of ECMO in assisting right heart function to ensure stable hemodynamics and myocardial recovery in the type A aortic dissection with coronary involvement.

STEMI: Wolf in Sheep’s Clothing With Double-Barrel Aorta

“…This emphasizes a rare presentation of aortic dissection as ST-elevation myocardial infarction and critical evaluation of simple tests as chest X-ray and echocardiography before taking for angiogram can avoid Cath Lab nightmares. 1, 2…”

“…CT aortogram revealed Type 1 DeBakey acute aortic dissection extending from aortic root (Figures 2C and 2D infarction and critical evaluation of simple tests as chest X-ray and echocardiography before taking for angiogram can avoid Cath Lab nightmares. 1,2…”

The Largest Operated Ascending Aortic Aneurysm in a Patient Without a History of Cardiac Surgery

“…Factors such as hypertension and collagen tissue diseases can be effective in the development of aneurysm and dissection. In addition, it has been shown that some molecular tissue factors may play a role in the development of aortic dissection in recent studies [ 3 , 4 ] . As Bicer et al point out, cystic medial necrosis is the most common cause of aneurysm.…”