PDF(Pubmed)
Abstract：
Mortality of type A aortic dissection (TAAD) complicated with coronary malperfusion syndrome is very high even when emergency surgery is performed. Several reports suggested that primary percutaneous coronary intervention (PPCI) followed by immediate corrective surgery may reduce mortality. In many countries, immediate transfer to an aortic surgery center may not be possible. We report a case of TAAD complicated by coronary malperfusion successfully treated with PPCI followed by elective corrective surgery. A 48-year-old man was referred to emergency department with acute inferior ST-elevation myocardial infarction (STEMI) and underwent PPCI. During the procedure, we realized that the cause of STEMI was TAAD. We decided to continue because the patient experienced seizures and bradycardia. Subsequently, echocardiography and computed tomography confirmed the dissection. The patient was discharged and referred to the National Cardiovascular Center where he underwent successful elective surgery. In this patient, immediate revascularization was lifesaving and served as a bridging procedure before surgical correction.
摘要：
即使进行急诊手术，A型主动脉夹层（TAAD）并发冠状动脉灌注不良综合征的死亡率也很高。一些报告表明，直接经皮冠状动脉介入治疗（PPCI）后立即进行矫正手术可能会降低死亡率。在许多国家,可能无法立即转移到主动脉手术中心.我们报告了一例TAAD并发冠状动脉灌注不良的病例，该病例通过PPCI成功治疗，然后进行了选择性矫正手术。一名48岁的男子因急性下壁ST段抬高型心肌梗死（STEMI）被转诊至急诊科，并接受了PPCI。在手术过程中,我们意识到STEMI的原因是TAAD。我们决定继续，因为患者经历了癫痫发作和心动过缓。随后，超声心动图和计算机断层扫描证实了夹层。患者出院并转诊至国家心血管中心，在那里他接受了成功的选择性手术。在这个病人身上,立即血运重建可以挽救生命,并作为手术矫正前的桥接程序.
