CASE SUMMARY
A 63-year-old female, a known case of hypertension presented to the
Emergency Department with the diagnosis of RCA dissection extending to
the ascending aorta following diagnostic coronary catheterization at a
local center done for evaluation of angina. As per records coronary
catheterization was performed via the right trans-radial approach.
Coronary catheterization(Figure-2A and 2B) demonstrated significant
disease in LAD (70% stenosis in the proximal part) and a tight RCA
ostial disease. On engaging the RCA and contrast injection, it was found
out that a dissection involving the ostial RCA and extending onto the
ascending aorta was present. A CT-angiogram(Figure-1) was also available
which showed a Type-A Aortic Dissection with the dissection flap
involving the RCA ostia and extending till the distal arch of aorta but
sparing the arch vessels. Echocardiography revealed massive pericardial
effusion. After initial resuscitation, the patient was taken up for
surgery. As per our standard protocol of cannulation and conduct of
bypass in emergent situations like aortic dissection. We proceeded with
distal ascending aortic cannulation using 18 Fr Femoral arterial
cannula. Simultaneous exposure of femoral vessels was done but
Femoro-Femoral bypass was not used. The ascending aorta was incised and
clots were evacuated from the ascending aorta and arch(Figure-3A).
Aortic root and aortic valve were normal. The patient underwent an
aortic interposition tube graft(30mm Intergard woven Dacron tube graft,
Maquet) with CABG(RSVG to distal-RCA and mid-LAD, Figure-3B). The
patient was hemodynamically stable in the post-operative period and was
discharged on postoperative day-8. The patient is doing well in the
follow-up clinic