The usefulness of an intravascular ultrasound in the diagnosis of left main coronary artery dissection

SummaryAcute type A aortic dissection occasionally involves coronary orifice which may lead to fatal myocardial infarction. We present a case with acute type A aortic dissection developing transient hemodynamic collapsing despite emergent surgical ascending aortic repair. Electrocardiogram after successful cardiopulmonary resuscitation suggested myocardial ischemia. Subsequent selective catheter coronary angiography conducted under percutaneous cardiopulmonary support system did not demonstrate the coronary dissection, but intravascular ultrasound (IVUS) clearly revealed the intimal flap and medial hematoma caused by dissection at left main coronary artery (LMCA). We performed stent implantation at LMCA as a bail-out procedure, and she was discharged after uneventful clinical course. IVUS was useful in this case for the precise diagnosis and making therapeutic strategy for dissection extending to LMCA.