Left ventricular failure despite patent coronary arteries in acute type A aortic dissection
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ID: 321834
2026
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Abstract
Severe myocardial failure after acute type A aortic dissection is usually attributed to structural coronary malperfusion. We report catastrophic global left ventricular failure despite preserved epicardial coronary anatomy, successfully bridged to durable mechanical circulatory support. A 57-year-old man presented with acute type A dissection and cardiogenic shock with extensive precordial ST-segment elevation. Emergency total arch replacement with frozen elephant trunk was performed. Intraoperative inspection and postoperative coronary angiography confirmed patent coronary ostia and arteries. Postoperatively, venoarterial extracorporeal membrane oxygenation plus a percutaneous microaxial flow pump were instituted; extracorporeal membrane oxygenation was weaned on day 4, but the patient remained pump-dependent. Perfusion imaging showed extensive fixed defects in the left coronary distribution, and durable left ventricular assist device implantation was required 6 weeks later. Severe myocardial injury can occur in acute type A aortic dissection without demonstrable fixed coronary obstruction. When dysfunction persists after successful repair, early viability assessment is essential to guide timely transition to durable mechanical circulatory support.
| Reference Key |
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| Authors | Daisuke Nakatsuka, Shun Sato, Yuichi Tara, Yasumasa Tsukamoto |
| Journal | Interdisciplinary CardioVascular and Thoracic Surgery |
| Year | 2026 |
| DOI |
10.1093/icvts/ivag204
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| URL | |
| Keywords | Keywords not found |
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