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Ann Thorac Surg 1995;59:585-590
© 1995 The Society of Thoracic Surgeons
Division of Cardiothoracic Surgery, Department of Surgery, Barnes Hospital and The Jewish Hospital of St. Louis, Washington University, St. Louis, Missouri, USA
Accepted for publication October 19, 1994.
* Address reprint requests to Dr Rosenbloom, Division of Cardiothoracic Surgery, Washington University School of Medicine, 3108 Queeny Tower, St. Louis, MO 63110.
The usefulness of preoperative coronary arteriography in patients with type A dissection of the aorta is controversial. To determine the prevalence of arteriosclerotic coronary artery disease in patients with type A dissection of the aorta, we reviewed our experience in 62 patients (42 with acute dissection and 20 with chronic dissection) who underwent operation between January 1, 1986, and December 31, 1993. Among 23 patients with acute dissection who underwent coronary arteriography, 8 (34.8%) had one or more coronary artery lesions causing a greater than 50% narrowing. Among 14 patients with chronic dissection who underwent coronary arteriography, 6 (42.9%) had one or more coronary artery lesions causing a greater than 50% narrowing. There were no fatal complications associated with coronary arteriography. Four patients with acute dissection and 6 patients with chronic dissection underwent coronary artery bypass grafting at the time of operative repair of the aortic dissection, with no operative deaths. On the basis of these findings and the success of combined coronary artery bypass grafting and aortic repair, we recommend that patients with an acute type A dissection who are in stable condition and all patients with a chronic type A dissection of the aorta should undergo preoperative coronary arteriography.
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