PMC7519782_01
PMC7519782_02
admission ECG showing prominent ST-segment elevations in inferior leads
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F1
Admission ECG showed ST-segment elevation in inferior leads suggesting acute inferior myocardial infarction (Figure 1).
transthoracic echocardiography: (A) a parasternal long-axis view showing dilated aortic root at sinus of Valsalva, left ventricular hypertrophy and small pericardial effusion; (B) a parasternal short-axis view of the aortic valve showing the dissection flap (arrow); (C) apical 5-chamber view of the severe aortic regurgitation in color doppler study
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F2
An urgent bedside transthoracic echocardiogram (TTE) revealed akinesia in the left inferior and lateral walls, a dilated aortic root (42 mm) with evidence of intimal tear in the ascending aorta, a significant aortic regurgitation (AR) with normal appearing aortic leaflets and small pericardial effusion (Figure 2).
aortic CT angiogram showing Stanford type A aortic dissection: (A) coronal section showing intimal dissection flap (arrow) and pericardial effusion; (B) three dimensionnally reconstructed image of aortic root, showing dissection flap, wich involve the right coronary artery (arrowhead)
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F3
Emergent CTA of the chest and abdomen was performed and demonstrated a 4.5 cm diameter ascending aorta with a Stanford type A (Debakey type II) acute dissection arising from the level of annulus aorta and a moderate pericardia effusion (Figure 3).
transesophageal echocardiogram: (A) short axis view of the aortic valve in systole showing the dissection flap (arrow) and right coronary artery arising from the false lumen of dissection (FL); (B) in diastole showing the incomplete closure of the aortic valve; (C) long axis view with color doppler demonstrating severe aortic regurgitation
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F4
AD beginning from sino-tubular junction with severe AR and the right coronary artery (RCA) was arising from the false lumen of dissection (Figure 4). After agreement between the cardiologist, the radiologist, the cardiovascular surgeon and the anesthetist, the diagnosis of dissection of the ascending aorta complicated of MI caused by malperfusion of the RCA and pericardial effusion, was confirmed and the decision for immediate surgical repair was made.
postoperative transthoracic echocardiography: (A) a parasternal long-axis view showing tube graft replacing the ascending aorta; (B) mild valvular AR in color doppler study
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F5
Echocardiographic evaluation 3 months after surgery showed mild valvular AR with LVEF 50% (Figure 5).