CTICasesAcute Myocardial Infarction of the Entire Coronary Artery Tree Post-Aortic Dissection Repair
Imaging findings
Dual-energy CT of the chest (reconstructed at 70 kV) shows a completely thrombosed descending aorta and severe surgical complications following Type A aortic dissection repair, including root replacement and reconstruction of the right coronary artery (RCA). Late-phase/delayed-contrast CT imaging demonstrates a lack of normal coronary artery flow and profound, diffuse, near-total circumferential subendocardial hypoenhancement and subsequent delayed hyperenhancement involving the entire left ventricular myocardium, with only mild focal sparing in the distal RCA territory.
Key takeaways
While diffuse subendocardial myocardial infarction/enhancement is classically considered an impossible diagnosis in surviving patients because near-total coronary occlusion is universally fatal, it can be visualized in patients kept alive mechanically via extra-corporeal membrane oxygenation (ECMO). This catastrophic presentation can occur after aortic dissection repairs involving coronary ostial reimplantation if surgical graft failure or acute global thrombosis of the coronary tree occurs, leading to a near-zero ejection fraction and high mortality.
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