Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
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Case Report

Volume 7, Number 5, May 2015, pages 356-360

Aortic Dissection Presenting as Acute Subtotal Left Main Coronary Artery Occlusion: A Case Approach and Review of the Literature

Figures

Figure 1.
Figure 1. Presenting 12-lead EKG revealing ST elevations in leads I, AVL, V1-V3 with significant ST depressions in the inferior leads.
Figure 2.
Figure 2. Subtotal occlusion of the left main coronary artery.
Figure 3.
Figure 3. Post-stenting of left main artery with good angiographic result.
Figure 4.
Figure 4. Aortogram revealing severe aortic regurgitation with possible dissection flap.
Figure 5.
Figure 5. Trans-esophageal echocardiography confirming aortic dissection of the ascending aorta.
Figure 6.
Figure 6. Short axis of aorta on TEE demonstrating dissection flap in lumen.
Figure 7.
Figure 7. Intra-vascular ultrasound (IVUS) dynamic flap outside the left main ostium.

Table

Table 1. Cases of Type A Aortic Dissection Presenting as Acute Myocardial Infarction Due to Left Main Occlusion
 
AuthorAgeSexPresentationPCISurgeryDx before PCIOutcome
Tominaga et al, 1999 [7]52WSyncope/shockNOSurgeryDischarge
Tominaga et al, 1999 [7]60WSTEMINOSurgeryDischarge
Barabas et al, 2000 [8]74MV.fib/STEMIPCI of LMSurgeryYesDischarge
Pinney and Wasserman, 2002 [9]46MSTEMINOSurgeryDischarge
Ohara et al, 2003 [10]67MSTEMI/shockPCI of LMNot a candidateNoDischarge/death 5 m later
Cardozo et al, 2004 [11]68MSTEMIPCI of LMNot a candidateYesDeath
Imoto et al, 2005 [12]71MDissection/shockPCI of LMStent graftYesDischarge
Zegers et al, 2007 [13]54MSTEMI/shockNOSurgeryDeath
Omar et al, 2007 [14]30WSTEMI/shockNOSurgeryDeath
Camaro et al, 2009 [15]52MNSTEMI/shockPCI of LMSurgeryNoDischarge
Saxena et al, 2011 [16]56MSTEMIPCI of LMSurgeryDischarge
Laine et al, 2011 [17]75MSTEMIPCI of LMSurgeryNoDeath
Ravandi and Penny, 2011 [18]86MSTEMIPCI of LMNot a candidateYes?
Lentini et al, 2013 [19]70MSTEMIPCI of LMSurgeryYesDischarge
Fallahi, 201361MSTEMIPCI of LMSurgeryNoDischarge