左主幹部病変による急性心筋梗塞を合併したStanford A型急性大動脈解離の1例

Stanford Type A Acute Aortic Dissection with Acute Myocardial Infarction due to Compression of Left Main Coronary Artery：Report of a Case

はじめに　急性大動脈解離（AAD）では，解離の波及や偽腔の圧排による分枝の灌流不全でさまざまな臓器虚血をきたしうる．AADに合併した急性冠症候群に対する治療は緊急外科手術が一般的であり，本邦のガイドラインでも言及されている1）．しかし，左主幹部（LMCA）の心筋梗塞を合併した大動脈解離では緊急外科手術を行っても予後は不良であり，有効な治療法について一定の見解がない．

A 58-year-old man was admitted to our institution with sudden onset of hypotension and acute ischemia of left lower extremity. Electrocardiography showed ST segment elevation in leads V1～V6 and a transthoracic echocardiogram revealed antero-septal wall hypokinesis. He was given a diagnosis of acute myocardial infarction caused by left main coronary artery compression due to acute aortic dissection by enhanced computed tomography. We implanted a stent in the left main coronary artery and performed right external iliac-left femoral arterial bypass under general anesthesia. We performed a conventional total arch replacement and frozen elephant trunk and mitral valve repair at day 16. His postoperative course was good. Implantation of a left main trunk stent is an effective strategy for Stanford type A acute aortic dissection with left main coronary arterial occlusion before surgical repair.