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