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.

Surgical treatment for 37 patients with acute type A aortic dissection involving coronary arteries / 中华胸心血管外科杂志

Objective To summarize the treatment experience and strategies of patients with acute type A aortic dissection involving coronary arteries in order to improve the efficacy of such patients.Methods Between March 2013 and April 2016,we recruited 37 patients with coronary involvement caused by acute type A aortic dissection,26 men,11 women;mean age (49.7 ± 10.4) years.All procedures were done on an emergency basis within 24 hours after the patient's arrival.Results Acute type A aortic dissection with coronary involvement is a more complex operation associated with high in-hospital mortality(18.9％,7/37) and low short-term survival(64.9％,13/37).There were 9 patients underwent coronary artery bypass graft after completion of the root procedure because of ventricular wall motion abnormality(7 patients) and new ST-segment elevation (2 patients) during weaning from cardiopulmonary bypass.Four of them were survival during follow-up due to the success from rescue coronary artery bypass graft.Conclusion Acute type A aortic dissection with coronary involvement is associated with high in-hospital mortality and low short-term survival.If patients suffered abnormal ventricular wall motion or new ST-segment elevation during weaning from cardiopulmonary bypass,rescue coronary artery bypass graft is essential to salvage these critically ill patients.

Update on Coronary Involvement in Fabry Disease

Abstract Fabry disease is a multisystemic disorder with consequent morbidity and mortality at an early age in patients of both genders. Although renal failure has been previously described as the cause of death with the highest prevalence, recent studies, based on the analysis of the population recorded in the Fabry Registry, reported that 40% of deaths had a cardiovascular origin. Data from the same registry emphasize the high risk for these patients suffering cardiovascular events—particularly acute myocardial infarction—and to the fact that this risk is higher for those patients who need dialysis. Microvascular dysfunction is a constant in patients with Fabry disease, which affects young patients, independently from other cardiac involvement manifestations—such as left ventricular hypertrophy—and from the patient's gender.

Comparison of Acute Clinical Features and Coronary Involvement in Patients with Kawasaki Disease between Those Younger and Older than One Year of Age

PURPOSE: To identify the necessity of more reasonable diagnostic criteria and the possibility of early prediction of coronary involvement in the higher risk group, we investigated and compared clinical and laboratory findings in the acute phase and coronary involvements in those younger (n=17) and older(n=53) than one year of age in Kawasaki disease(KD). METHODS: Retrospective chart reviews were performed on 70 patients with KD who were admitted to the Chung-Ang University Hospital from April 1997 to May 2001. RESULTS: Male were significantly higher in the younger age group(M : F ratio 3.3 : 1 vs. 1.0 : 1, P=0.004). Fever durations before intravenous immunoglobulin(IVIG) and echocardiography were significantly shorter in the younger group(4.6+/-1.3 vs. 6.2+/-2.5, P=0.004 vs. 0.01, respectively). Cases meeting typical diagnostic criteria were significantly less in the younger group(P=0.006). In the laboratory findings, serum albumin, BUN and K+ levels in the acute febrile phase were significantly higher in the younger group(P=0.002, 0.006, <0.001, respectively) and incidences of coronary artery dilatation in the acute phase were significantly higher in the younger group(P=0.01). CONCLUSION: Although less met the typical diagnostic criteria of KD, infants younger than one year of age are more susceptible to coronary artery change in the acute febrile phase. Therefore, KD should be entertained as a diagnostic possibility in young infants with prolonged fever without distinct fever focus, and echocardiography should be considered as part of the evaluation of these patients, and then early diagnosis and prompt IVIG should be conducted.