What is the clinical evidence from this study?

Study design: Case Report. Population: Stanford type A aortic dissection with single coronary artery (n=1). Intervention: Redo sternotomy and ascending aortic replacement. Primary outcome: Survival and discharge without ischemic symptoms.

What question did this study set out to answer?

To report a rare case of type A aortic dissection associated with a single coronary artery following aortic valve replacement.

June 12, 2026Open Access

A Case of Type A Aortic Dissection with Single Coronary Artery after Aortic Valve Replacement

CYChihiro YokoyamaShiga University of Medical Science NTNoriyuki TakashimaShiga University of Medical Science 斉渓斉藤渓Shiga University of Medical Science

Key Result

A 56-year-old woman with a single coronary artery and Stanford type A aortic dissection successfully underwent redo ascending aortic replacement with preservation of the single coronary artery.

Key Points

To report a rare case of type A aortic dissection associated with a single coronary artery following aortic valve replacement.
Conducted a CT scan to identify aortic dissection and coronary anatomy in a 56-year-old female patient.
Performed ascending aortic replacement surgery while preserving the mechanical aortic valve.
Monitored postoperative recovery and assessed for ischemic symptoms.
Aortic dissection was discovered incidentally during routine follow-up CT.
Single coronary artery anatomy noted, with no signs of myocardial ischemia post-surgery.
Patient had an uneventful recovery and was discharged 12 days post-operation.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 56-year-old woman with a history of aortic valve replacement who presented with a DeBakey type II aortic dissection and an incidentally found single coronary artery.

Intervention

Redo sternotomy and ascending aortic replacement with preservation of the previously implanted mechanical valve and the single coronary artery.

Outcome

Successful surgical repair and postoperative recovery without ischemic symptoms.

Ascending aortic replacement can be safely performed while preserving a single coronary artery in a patient with Stanford type A aortic dissection and a history of aortic valve replacement.

Limitations

Preoperative evaluation of ischemia could not be performed due to the high risk associated with ascending aortic dissection
Single case report requiring careful long-term follow-up

Abstract

症例は56歳女性．大動脈弁置換術後の定期外来で行ったCT検査で偶発的にStanford A型（DeBakey II型）大動脈解離を認め当科を紹介され受診した．冠動脈CTで右冠動脈洞から起始する単一冠動脈を認め，左冠動脈は大動脈-肺動脈間を走行し主幹部に壁内走行または狭窄を疑う所見を認めた．大動脈解離の発症時期は不明であったがValsalva洞は著明に拡大しており手術の方針となった．再胸骨正中切開で上行大動脈置換術を行い，大動脈弁に留置されていた機械弁は温存した．単一冠動脈は右冠動脈洞から起始しすぐに右冠動脈と左冠動脈に分岐していた．左冠動脈は大動脈と肺動脈の間を走行し壁内走行やスリット状開口部のような心筋虚血や突然死の危険性が高い解剖を認めなかった．単一冠動脈は温存可能であったため上行大動脈置換術のみを行った．術後経過は良好で，虚血症状もなく術後12日目に退院した．開心術後遠隔期の，単一冠動脈を伴うStanfordA型大動脈解離は非常に稀であり，文献的考察を加えて報告する．

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