急性 A 型主动脉夹层的不常见表现：套状撕裂和外翻的近端右冠状动脉内膜，无心肌缺血。
Uncommon presentation of acute type A aortic dissection: sleeve-severed and everted proximal right coronary artery intima without myocardial ischaemia.
机构信息
Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , 167#Beilishi Road, Beijing, 100037, China.
Department of Cardiovascular Surgery, Affiliated Hospital of Chengde Medical University, Chengde, 067000, China.
出版信息
J Cardiothorac Surg. 2024 Sep 20;19(1):538. doi: 10.1186/s13019-024-03040-y.
BACKGROUND
Type A aortic dissection (TAAD) with coronary involvement is rare but potentially fatal. Proper myocardial protection during surgery is essential.
CASE PRESENTATION
Here, we describe a 52-year-old woman who presented with sudden chest pain. CT angiography revealed TAAD with right coronary artery involvement. During surgery, the proximal intima of the right coronary artery was found to be completely severed and everted. Conventional myocardial perfusion methods were inadequate. A patented perfusion tip for coronary artery orifice perfusion was used, resulting in favourable surgical outcomes. The patient was discharged without complications.
CONCLUSIONS
This case emphasizes the need for careful preoperative assessment of coronary involvement in TAAD patients. The myocardial protection method used here is very helpful and can be applied effectively in similar cases encountered by surgeons.
背景
合并冠状动脉受累的 A 型主动脉夹层（TAAD）罕见但潜在致命。手术期间适当的心肌保护至关重要。
病例介绍
这里，我们描述了一位 52 岁女性，她突发胸痛就诊。CT 血管造影显示 TAAD 合并右冠状动脉受累。手术中发现右冠状动脉近端内膜完全撕裂并翻转。常规心肌灌注方法不足。使用了一种专利的冠状动脉口灌注灌注尖端，从而获得了良好的手术结果。患者无并发症出院。
结论
本例强调了在 TAAD 患者中仔细术前评估冠状动脉受累的必要性。这里使用的心肌保护方法非常有帮助，并且可以在外科医生遇到的类似情况下有效应用。
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