Stefanidis C, Sanoussi A, Demanet H, Castro-Rodriguez J, Wauthy P
Services de Chirurgie Cardiaque, C.H.U. Brugmann.
Rev Med Brux. 2011 May-Jun;32(3):179-81.
Myocardial ischemia secondary to dissection of the ascending aorta remains a relatively rare complication. A 76-year old man with no prior history developed sudden chest pain. The electrocardiogram showed a ST-segment elevation in leads II and III suggesting an inferior wall acute myocardial infarction. Upon arrival, he received anticoagulation and antiplatelet aggregation intravenously and orally respectively. Coronary angiography showed an anomalous origin of the right coronary and extrinsic stenosis by a false lumen. Computed tomography confirmed the diagnosis of type A aortic dissection with an extension to the right coronary. Emergency ascending aorta replacement with Dacron graft and a right coronary artery graft was perfomed. This case illustrates how myocardial infarction can mask an aortic dissection. The initial treatment of a myocardial infarction with anticoagulation and/or oral antiplatelet aggregation should not be modified, even if it increases postoperative bleeding when emergent cardiac surgery is necessary.
升主动脉夹层继发的心肌缺血仍然是一种相对罕见的并发症。一名既往无病史的76岁男性突发胸痛。心电图显示Ⅱ、Ⅲ导联ST段抬高，提示下壁急性心肌梗死。入院时，他分别接受了静脉抗凝和口服抗血小板聚集治疗。冠状动脉造影显示右冠状动脉起源异常，假腔造成外在狭窄。计算机断层扫描证实为A型主动脉夹层，并累及右冠状动脉。急诊行涤纶人工血管升主动脉置换术及右冠状动脉移植术。该病例说明了心肌梗死如何掩盖主动脉夹层。即使在需要急诊心脏手术时增加术后出血风险，心肌梗死最初的抗凝和/或口服抗血小板聚集治疗也不应改变。
