The "high take-off" left main coronary artery in a patient with acute type A aortic dissection.

Abstract

A 73-year-old woman with a history of hypertension was admitted to the emergency room for chest pain and dyspnea. A chest radiograph showed mediastinal widening and increased cardiothoracic ratio (Figure 1A). Electrocardiography showed normal sinus rhythm without any ST changes (Figure 1B). Preoperative echocardiography was unremarkable except for moderate pericardial effusion. Enhanced computed tomography (CT) revealed acute type A aortic dissection with moderate amount of pericardial effusion and ectopic high origin of the left main coronary artery (LMCA; Figure 1C). Figure 1. The preoperative diagnostic work-ups. A , The preoperative chest x-ray shows mediastinal widening and increased cardiothoracic ratio. B , The preoperative EKG shows normal sinus rhythm without any ST changes. C , Computed tomography shows the ostium of the left main coronary artery to be at ≈28 mm above the aortic valve and moderate amount of pericardial effusion (*). AoV indicates aortic valve; and LM, left main coronary artery. Emergency surgery was performed under cardiopulmonary bypass with cardioplegic arrest. During surgery, we recognized that LMCA originated ≈28 mm above the aortic valve and coursed down extramurally (Figure 2). LMCA was mobilized cautiously and separated from the aortic wall. After …