Acute myocardial infarction due to spontaneous, localized, acute dissection of the sinus of Valsalva detected by intravascular ultrasound and electrocardiogram-gated computed tomography.

• 影响指数: 1.814
• 发表时间: Sep 2016
• 来源期刊: Heart Vessels
• DOI: 10.1007/s00380-015-0787-5
• PMID: 26710761
• 文章类型: Case Reports
• 中科院分区: Q3
• 方向: 医学
• 作者列表: Ichihashi T,Ito T,Murai S,Ikehara N,Fujita H,Suda H,Ohte N

关键词: Aortic dissection; Coronary malperfusion; Electrocardiogram-gated computed tomography; Intravascular ultrasound

Mesh: Acute Disease; Aneurysm, Dissecting / complications diagnostic imaging physiopathology surgery; Aortic Aneurysm / complications diagnostic imaging physiopathology surgery; Aortic Valve Insufficiency / diagnostic imaging etiology; Aortography / methods; Blood Vessel Prosthesis Implantation; Cardiac-Gated Imaging Techniques; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Bypass; Echocardiography, Doppler, Color; Electrocardiography; Hemodynamics; Humans; Male; Middle Aged; Percutaneous Coronary Intervention / instrumentation; Predictive Value of Tests; ST Elevation Myocardial Infarction / diagnosis etiology physiopathology therapy; Sinus of Valsalva / diagnostic imaging physiopathology; Stents; Treatment Outcome; Ultrasonography, Interventional

Abstract

A 58-year-old man was referred to our hospital because of chest pain. The 12-lead electrocardiogram (ECG) revealed ST-segment elevation in II, III, and a Vf with advanced heart block. Transthoracic echocardiography demonstrated aortic root dilatation at the sinus of Valsalva, moderate aortic regurgitation, and decreased wall motion in the inferior part of the left ventricle. Non-ECG-gated enhanced computed tomography (CT) did not reveal an aortic dissection. The patient underwent emergent coronary angiography, which revealed a severely narrowed ostium of the right coronary artery (RCA). Percutaneous coronary intervention (PCI) was performed under intravascular ultrasound (IVUS) guidance. IVUS images demonstrated an intimal flap extending from the aortic wall to the proximal RCA, suggesting that a periaortic hematoma in the false lumen compressed the ostium of the RCA, leading to acute myocardial infarction. To recover hemodynamic stability, the RCA ostium was stented. Subsequent ECG-gated enhanced CT clearly depicted the entry point and extension of the dissection localized within the sinus of Valsalva. The dissection likely involved the left main coronary artery and an emergent Bentall procedure was performed. Intraoperative findings confirmed an intimal tear and extension of the dissection. Thus, ECG-gated CT can clearly depict the entry site and extension of a dissection occurring in the localized area that cannot be detected by conventional CT.