JACC. Case reports · 2026
Acute Myocardial Infarction Secondary to Idiopathic Ascending Aortic Thrombus.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Melo-González Nathalia, Madrid-Marín Ana Lucía, Castaño-Cifuentes Orlando, Arrieta-Mendoza Martín Elías
Аннотация
BACKGROUND: Ascending aortic thrombus causing acute myocardial infarction through coronary ostial occlusion is exceptional, with only 74 cases reported globally, and may mimic acute aortic dissection on imaging.
CASE SUMMARY: A 48-year-old man with no prior history presented with ST-elevation myocardial infarction. Coronary angiography showed near-total right coronary artery ostial occlusion with a right sinus of Valsalva lesion. Echocardiography revealed a mobile aortic root mass. Computed tomography angiography raised concern for Type A dissection. Emergency surgery revealed a 4 × 2-cm organized thrombus with no dissection. Thrombectomy and saphenous vein bypass were performed. Histopathology confirmed organized thrombus; cultures and thrombophilia workup were negative. Discharged on dual-antiplatelet therapy.
DISCUSSION: Idiopathic aortic sinus thrombus can mimic acute aortic syndrome while causing coronary ischemia, potentially as a chronic process with acute decompensation. Surgical excision with revascularization is definitive.
TAKE-HOME MESSAGES: Aortic root thrombus must be included in the differential of unexplained coronary ostial occlusion in young patients. Emergent surgical exploration enables simultaneous diagnosis and treatment.
CASE SUMMARY: A 48-year-old man with no prior history presented with ST-elevation myocardial infarction. Coronary angiography showed near-total right coronary artery ostial occlusion with a right sinus of Valsalva lesion. Echocardiography revealed a mobile aortic root mass. Computed tomography angiography raised concern for Type A dissection. Emergency surgery revealed a 4 × 2-cm organized thrombus with no dissection. Thrombectomy and saphenous vein bypass were performed. Histopathology confirmed organized thrombus; cultures and thrombophilia workup were negative. Discharged on dual-antiplatelet therapy.
DISCUSSION: Idiopathic aortic sinus thrombus can mimic acute aortic syndrome while causing coronary ischemia, potentially as a chronic process with acute decompensation. Surgical excision with revascularization is definitive.
TAKE-HOME MESSAGES: Aortic root thrombus must be included in the differential of unexplained coronary ostial occlusion in young patients. Emergent surgical exploration enables simultaneous diagnosis and treatment.