Key result
Prompt multimodal rescue with CSF drainage, naloxone, and steroids reverses postoperative paraplegia after aortic repair.
Why the study?
Coronary malperfusion and paraplegia are rare but severe complications of Stanford type A acute aortic dissection, and their co-occurrence is extremely rare.
Does prompt surgical repair followed by medical management with naloxone, CSF drainage, and methylprednisolone improve clinical and neurological outcomes in a patient with type A aortic dissection complicated by right coronary malperfusion and paraplegia?
Case Report (n=1)
No
Does prompt surgical repair followed by medical management with naloxone, CSF drainage, and methylprednisolone improve clinical and neurological outcomes in a patient with type A aortic dissection complicated by right coronary malperfusion and paraplegia?
This case demonstrates that emergent surgical repair followed by early targeted medical management (naloxone, CSF drainage, steroids) can yield excellent neurological and survival outcomes in type A aortic dissection complicated by malperfusion and paraplegia.
May support adjunctive naloxone, drainage, and steroids for paraplegia after type A repair; hypothesis-generating and should not yet change practice.
Both coronary malperfusion and paraplegia are fatal complications of type A aortic dissection. We report a rare case of successful surgical repair for type A aortic dissection simultaneously complicated with both right coronary malperfusion and paraplegia. A 44-year-old man was admitted to our hospital with sudden chest and back pain. ST elevation and atrioventricular block were shown in an electrocardiogram. The echocardiogram demonstrated asynergy of left ventricular wall motion in the inferior and posterior area. Enhanced computed tomography revealed type A aortic dissection with right coronary malperfusion. We performed emergent repair of the ascending aorta and aortic arch without implantation of a coronary stent prior to the surgical repair. After the operation, satisfactory right coronary revascularization was obtained. However, after the patient woke up from anesthesia, paraplegia was recognized. The paraplegia was successfully treated with acute administration of naloxone, acute cerebrospinal fluid drainage and subacute administration of a large dose of methylprednisolone. He was discharged without any neurologic deficits on the 49 th postoperative day. Jpn. J. Cardiovasc. Surg. 50 : 128 - 132 （ 2021 ）
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Ito et al. (2021) conducted a case report in Acute type A aortic dissection complicated by right coronary malperfusion and paraplegia (n=1). Emergent surgical repair (ascending aorta and aortic arch replacement) followed by naloxone, CSF drainage, and methylprednisolone was evaluated on Neurological recovery and hospital discharge. The patient successfully underwent emergent surgical repair of the aorta and recovered from postoperative paraplegia after prompt administration of naloxone, CSF drainage, and methylprednisolone, being discharged without neurologic deficits on day 49.
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