Conservatively treated coronary malperfusion associated with acute type A dissection before aortic root replacement

Coronary malperfusion associated with aortic dissection usually requires aggressive surgical treatment or catheter revascularization. Here, we report a case of conservatively treated coronary malperfusion associated with acute type A dissection before aortic root replacement. An 81-year-old woman was rushed to our hospital in a state of circulatory shock after developing chest pain. She was severely hypotensive on admission, and the electrocardiogram (ECG) revealed anterior and lateral ST elevation. However, the initial fluid resuscitation increased her blood pressure to a normal level, and the ischemic ECG changes disappeared in about 20 min. ECG-gated cardiac multidetector computed tomography showed a type A aortic dissection complicated with left main trunk dissection. A primary entry tear was located 5 mm below the left coronary ostium. The patient successfully underwent composite graft replacement of the aortic root in a stable hemodynamic condition. <Learning objective: Emergency clinicians should be aware that coronary malperfusion associated with aortic dissection can be improved by conservative management in some cases. Electrocardiogram-gated cardiac multidetector computed tomography is a useful tool for the diagnosis and clinical management of this condition.>.