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A Case of Surgical Treatment for Acute Type A Aortic Dissection with ‘Flap Suffocation’ Causing Myocardial Ischemia
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（Department of Cardiovascular Surgery, Obihiro Kousei General Hospital, Obihiro, Japan, and Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University Hospital＊, Sapporo, Japan）
| Hiroyuki Satoh |
Hidetoshi Yamauchi |
Tomoyoshi Yamashita |
| Yoshiro Matsui＊ |
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A 52 year-old man was admitted to our institution with sudden onset of severe chest and back pain. The electrocardiogram showed ST segment depression in leads I, II, aVL, aVF, V3-6. Emergent coronary angiogram was performed, but the catheter did not reach to the coronary ostia, and it only performed false lumen aortogram. Computed tomography showed acute Stanford A aortic dissection. Ultrasound echocardiography also showed aortic regurgitation 3/4 degree. We decided to perform an emergency operation. During anesthesia induction, systemic blood pressure fell below 80mmHg during systolic period, and pulmonary pressure raised to 60mmHg. Transesophageal echography showed the movements of dissection flap intermittently obstructed the coronary blood flow and aortic valve annuls. Those flap movements, so called ‘flap suffocation’ was thought to be the cause of cardiac failure. Intra-operative findings of the ascending aorta showed an entry of dissection just above the left coronary ostia, and the entire detachment of intima to aortic wall. We performed ascending aorta replacement with aortic valve resuspension and fixation of coronary ostia. The postoperative course was uneventful, and he was discharged on the 25th postoperative day. For the precise treatment of acute Stanford A aortic dissection with such coronary ischemia, quick diagnosis and operative correction is essential.
Jpn. J. Cardiovasc. Surg. 42:302-306（2013）
Keywords：acute type A aortic dissection, acute myocardial ischemia, flap suffocation
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