What question did this study set out to answer?

To present a rare case of single coronary artery discovered during surgery for Stanford Type A acute aortic dissection.

June 12, 2026Open Access

A Case of Single Coronary Artery with Stanford Type A Acute Aortic Dissection

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Stanford type A acute aortic dissection with single coronary artery (n=1). Intervention: Emergency ascending aortic replacement with selective and retrograde cardioplegia. Primary outcome: Survival and recovery without perioperative myocardial ischemia.

ANAkihiro NakamuraNiigata Prefectural Shibata Hospital RKRyohei KobayashiMusashino Red Cross Hospital KSKoji ShimadaNiigata Prefectural Shibata Hospital

Key Result

Emergency ascending aortic replacement using selective and retrograde cardioplegia was successfully performed without myocardial ischemia in a patient with acute aortic dissection and a rare single coronary artery.

Key Points

To present a rare case of single coronary artery discovered during surgery for Stanford Type A acute aortic dissection.
Emergency surgery was performed following CT diagnosis of Stanford Type A acute aortic dissection.
During surgery, only one coronary opening was found in the right coronary sinus, indicating a single coronary artery.
Selective retrograde myocardial protection was applied during the ascending aorta replacement.
Single coronary artery was diagnosed as Lipton classification R-III on post-operative CT.
No perioperative myocardial ischemia occurred during the surgical process.
The case illustrates the rarity and complexities of single coronary artery associated with acute aortic dissection.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 70-year-old woman presenting with Stanford type A acute aortic dissection and an incidentally discovered Lipton type R-III single coronary artery who underwent emergency surgery.

Intervention

Emergency ascending aortic replacement using selective and retrograde cardioplegia.

Outcome

Surgical success and perioperative survival without myocardial ischemia.

This is the first reported case of a Lipton type R-III single coronary artery complicated by acute aortic dissection, highlighting the importance of retrograde cardioplegia for myocardial protection when anomalous coronary origins are incidentally found during emergency surgery.

Limitations

Preoperative diagnosis of anomalous coronary origin is difficult using routine, non-ECG-gated CT in emergency settings.
Intraoperative identification of the anomalous coronary course is challenging, posing a risk of coronary artery injury.

Abstract

症例は70歳，女性．めまいと胸背部痛を主訴に救急外来を受診し，CTでStanford A型急性大動脈解離の所見を認めた．心電図に異常所見はなく，経胸壁心エコーでは心収縮は良好で壁運動異常は認めなかった．緊急手術を行ったところ，術中所見にて左冠洞には明らかな冠動脈開口部を認めず，右冠洞に大きな冠動脈開口部が1つのみあることが発見された．単一冠動脈と判断し，選択的および逆行性に心筋保護液を注入して手術手技を進め，上行置換術を遂行した．人工心肺からの離脱はスムーズで，周術期に心筋虚血を生ずることなく軽快した．術後のCTにて冠動脈は右冠洞から単一で起始し，右冠動脈と左前下行枝，左回旋枝がそれぞれ独立して分岐する，Lipton分類R-III型の単一冠動脈と診断された．Lipton分類R-III型は単一冠動脈の中でも頻度が低く，大動脈解離に合併し，かつ緊急手術中に発見されることはきわめて稀である．非心電図同期CTでは冠動脈起始異常を診断することは容易ではなく，術中発見時は心筋保護の確立と冠動脈損傷の回避が重要と考えられる．

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Cite This Study

Nakamura et al. (Fri,) conducted a case report in Stanford type A acute aortic dissection with single coronary artery (n=1). Emergency ascending aortic replacement with selective and retrograde cardioplegia was evaluated on Survival and recovery without perioperative myocardial ischemia. Emergency ascending aortic replacement using selective and retrograde cardioplegia was successfully performed without myocardial ischemia in a patient with acute aortic dissection and a rare single coronary artery.

synapsesocial.com/papers/6a2ba20e8101cf8926f01327 https://doi.org/https://doi.org/10.4326/jjcvs.55.142

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