An unusual presentation requiring an unusual intervention

Author(s): Hussain Alzayer, Matthias Bossard, Ashraf Alazzoni, Dominic Parry, Madhu K. Natarajan

Stanford type A aortic dissection is associated with significant morbidity and mortality. Acute myocardial infarction is a rare complication and can occur in 3% of patients due to retrograde extension of the dissection leading to coronary malperfusion. Involvement of the right coronary artery is more common. On the other hand, Left Main Coronary Artery (LMCA) occlusion is unusual and if unrecognised, can result in rapid hemodynamic deterioration with cardiogenic shock and eventually death. Emergent surgical repair is the definitive treatment. Intra-Aortic Balloon Pump (IABP) is frequently used in the setting of cardiogenic shock due to LMCA stenosis. In this case it was inserted before the diagnosis of type A aortic dissection was made. This represents a unique case of type A aortic dissection resulting in severe ostial left main coronary artery stenosis in which the IABP was successfully used as a bridge therapy to definitive surgical repair.