Zhang Yun-Xiao, Yang Hang, Wang Gui-Song
Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing 100191, China.
Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China.
World J Clin Cases. 2021 Feb 6;9(4):970-975. doi: 10.12998/wjcc.v9.i4.970.
Aortic dissection (AD) is an emergent and life-threatening disorder, and its in-hospital mortality was reported to be as high as 24.4%-27.4%. AD can mimic other more common disorders, especially acute myocardial infarction (AMI), in terms of both symptoms and electrocardiogram changes. Reperfusion for patients with AD may result in catastrophic outcomes. Increased awareness of AD can be helpful for early diagnosis, especially among younger patients.
We report a 28-year-old man with acute left side chest pain without cardiovascular risk factors. He was diagnosed with acute inferior ST-segment elevation myocardial infarction (STEMI), which, based on illness history, physical examination, and intraoperative findings, was eventually determined to be type A AD caused by Marfan syndrome. Emergent coronary angiography revealed the anomalous origin of the right coronary artery as well as eccentric stenosis of the proximal segment. Subsequently, computed tomography angiography (CTA) showed intramural thrombosis of the ascending aorta. Finally, the patient was transferred to the cardiovascular surgery department for a Bentall operation. He was discharged 13 d after the operation, and aortic CTA proved a full recovery at the 2-year follow-up.
It is essential and challenging to differentiate AD from AMI. Type A AD should be the primary consideration in younger STEMI patients without cardiovascular risk factors but with outstanding features of Marfan syndrome.
主动脉夹层（AD）是一种紧急且危及生命的疾病，据报道其院内死亡率高达24.4%-27.4%。AD在症状和心电图改变方面可类似于其他更常见的疾病，尤其是急性心肌梗死（AMI）。对AD患者进行再灌注可能会导致灾难性后果。提高对AD的认识有助于早期诊断，尤其是在年轻患者中。
我们报告一名28岁男性，有急性左侧胸痛，无心血管危险因素。他被诊断为急性下壁ST段抬高型心肌梗死（STEMI），根据病史、体格检查和术中发现，最终确定为由马方综合征引起的A型AD。急诊冠状动脉造影显示右冠状动脉起源异常以及近端节段偏心性狭窄。随后，计算机断层血管造影（CTA）显示升主动脉壁内血栓形成。最后，患者被转至心血管外科进行Bentall手术。术后13天出院，2年随访时主动脉CTA显示完全恢复。
将AD与AMI区分开来至关重要且具有挑战性。对于无心血管危险因素但具有明显马方综合征特征的年轻STEMI患者，应首要考虑A型AD。
