Progression of left coronary artery dissection during and after aortic replacement in acute type A aortic dissection: a case report.

A 69-year-old man was transferred to our hospital with a diagnosis of acute type A aortic dissection. In the emergent operation, the dissection was found to extend to the orifice of the left coronary artery, but not to the coronary artery itself. The false lumen was closed using glue and sutures with felt strips, and graft replacement of the ascending aorta was performed. However, signs of myocardial ischemia were present after the operation, and the patient's condition continued to be unstable, even though intraaortic balloon pumping was initiated. A coronary angiogram and intravascular ultrasound performed three hours after the operation revealed a left main trunk stenosis due to pulsatile compression of the false lumen, which was caused by the extension of dissection. A coronary artery stent was subsequently deployed in the left main trunk. The patient was discharged four weeks later in a stable condition, although with segmental asynergy of wall motion, due to myocardial damage.