Guillermo Reyes1,3*, Christian Munoz3, Jose Maria Cortina2,3 and Vicente Gomez-Tello3
1Department of Cardiac Surgery, Hospital Universitario La Princesa, Spain
2Department of Cardiac Surgery, Hospital Universitario 12 de Octubre, Spain
3Department of Cardiac Surgery, Hospital Universitario Moncloa, Spain
A 64-year-old man with no known medical history was admitted to the hospital with suspicion of inferior wall cardiac infarction and antifibrinolytic and antiplatelet therapy was administrated. As the patient continued with ongoing chest pain an emergent coronariography was performed. No lesions were found in the left coronary artery. However, a complete occlusion of the right coronary ostia and an acute aortic dissection was diagnosed. CT scan revealed an aortic dissection affecting the ascending aorta with no flow through the right coronary artery. An aortic calcified valve was also found. Patient was referred to the operating room for emergency surgery. Time elapsed between patient admission and surgery was 12 h. Transesophageal echocardiogram was performed showing an ascending aorta dissection with a severe aortic valve stenosis. Severe right ventricle dysfunction was also present. Aorta tear was found one centimeter above the sinotubular junction. Aortic dissection reached the proximal part of the aortic arch. A severe aortic stenosis was also found. A total section of the right coronary artery was found. The right coronary ostia were completely everted and protruding inside the aorta lumen. An aortic valve replacement and ascending aorta and Hemiarch replacement was performed. A bypass with vein graft to the right coronary artery was also performed. When weaned the bypass a severe right ventricle dysfunction was observed. Also severe bleeding in the surgical field happened due to the medical therapy previously given. Patient could hardly be weaned from bypass and died a few hours after surgery.
Aortic dissection; Acute coronary syndrome; Coronary ostia rupture
Reyes G, Munoz C, Cortina JM, Gomez-Tello V. Complete Disruption and Eversion of the Right Coronary Ostium after Acute Aortic Dissection. Ann Cardiovasc Surg. 2020;3(1):1023..