PP-227 ACUTE ANTERIOR MYOCARDIAL INFARCTION DUE TO AN ACUTE AORTIC DISSECTION INVOLVING THE LEFT MAIN CORONARY ARTERY

We report a case of anterior myocardial infarction due to a Stanford type A aortic dissection involving the left main trunk of the coronary artery. Acute myocardial infarction due to extension of an acute Stanford type A aortic dissection is a rare but lethal situation. A 54-year-old man with a history of hypertension was referred to our hospital with a sudden onset of severe chest pain which started one hour earlier. The ECG showed extensive ST-segment elevation in the anterior and lateral leads suggesting acute anterior myocardial infarction (Figure 1a). On physical examination general health situation was moderate. His heart rate was 98 bpm and blood pressure was 100/70mmHg. First and second heart sound was normal. There was no additional heart sound or murmur. Emergent coronary angiography demonstrated an aortic dissection located at the sinus of Valsalva and ascending aorta. The false lumen originated from the sinus of Valsalva and involved the left main coronary artery. Total occlusion of the left main coronary artery with TIMI 0 flow was seen (Figure 1b). The patient was transferred for emergency surgery. Postoperatively, an intra-aortic balloon pump was inserted because of haemodynamic instability due to the left ventricular myocardial injury. The patient discharged 21 days after surgery in good health status. Acute myocardial infarction due to extension of an acute Stanford type A aortic dissection is a rare but lethal situation. Several case reports of a Stanford type A aortic dissection in combination with a myocardial infarction have been published. In almost all cases the right coronary artery was involved. In our case a spontaneous aortocoronary dissection involving the left Valsalva sinus and the ascending aorta with a history of hypertension is the most plausible cause.