Transesophageal Echocardiographic Evaluation of Coronary Blood Flow and the Initial Flap Assisting in the Surgical Decision-Making: A Case of Acute Type A Aortic Dissection

• Published in: Cureus Vol. 16; no. 6; p. e61872
• Main Authors: Sumii, Keisuke, Ichimura, Takuya, Nakagawa, Hideyuki, Kitamura, Akira
• Format: Journal Article
• Language: English
• Published: United States Springer Science and Business Media LLC 07.06.2024; Springer Nature B.V; Cureus
• Subjects: Anesthesiology; Aortic dissection; Cardiac/Thoracic/Vascular Surgery; Case reports; Clinical decision making; Doppler effect; Electrocardiography; Heart surgery; Medical imaging; Veins & arteries; coronary artery blood flow; aortic flap; transesophageal echocardiography; pulsed doppler; aortic dissection
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.61872

Acute aortic dissection is a life-threatening condition. Myocardial ischemia associated with dissection occurs due to direct extension into the coronary artery or indirect involvement of the coronary ostia secondary to the dissection flap. Thus, the surgical procedure may require coronary reconstruction, in addition to aortic replacement. We experienced a case in which coronary artery reconstruction could be avoided because intraoperative transesophageal echocardiography showed that the aortic flap did not obstruct the right coronary artery in systole, and pulsed Doppler imaging indicated that there was sufficient coronary blood flow. This case shows that it is critical to establish a correct and early diagnosis and to proceed with the appropriate treatment for patients with myocardial ischemia.