Left main coronary malperfusion from acute non-communicating aortic dissection.

A 64-year-old man was admitted with sudden back and chest pain. He had undergone aortic valve replacement 5 years earlier. Enhanced computed tomography showed acute type A non-communicating aortic dissection. He was initially treated with supportive medical therapy. Since he was restless, he was placed on a respirator. He went into sudden shock 6 h after onset. Percutaneous cardiopulmonary support was administered, and coronary arteriography showed progression of the dissection to the left main trunk. Percutaneous coronary intervention was performed. He recovered from shock and then underwent ascending aorta replacement. He was discharged from hospital without any major complications.