Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome Eugenio Neri, MDa, Thomas Toscano, MD, PhDa, Ugo Papalia,

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Proximal aortic dissection with coronary malperfusion: Presentation, management, and outcome Eugenio Neri, MDa, Thomas Toscano, MD, PhDa, Ugo Papalia, MDb, Giacomo Frati, MDa, Massimo Massetti, MDa, Gianni Capannini, MDa, Enrico Tucci, MDa, Dimitri Buklas, MDa, Luigi Muzzi, MDa, Luca Oricchio, MDa, Carlo Sassi, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 121, Issue 3, Pages 552-560 (March 2001) DOI: 10.1067/mtc.2001.112534 Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Three main types of coronary lesion due to proximal dissection: type A, ostial dissection (A); type B, dissection with a coronary false channel (B); type C, circumferential detachment with an inner cylinder intussusception (C). The Journal of Thoracic and Cardiovascular Surgery 2001 121, 552-560DOI: (10.1067/mtc.2001.112534) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 When the dissection reaches the ostium, without disrupting the coronary vessel (type A), the coronary ostium is excised in button form, with a 4-mm margin of the surrounding aortic wall (A). The dissected layers around the ostium are then conjoined with gelatin-resorcin-formalin glue and an over-and-over 6-0 suture (B). The ostial button then is anastomosed to the tube graft without torsion or tension (C). The Journal of Thoracic and Cardiovascular Surgery 2001 121, 552-560DOI: (10.1067/mtc.2001.112534) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 In the event of type B lesions (A), the coronary artery is incised longitudinally (B) and patch repair is performed with a continuous 7-0 polypropylene suture conjoining the dissected arterial layers and the patch (C). The repaired artery is then anastomosed to the aortic graft (D). The Journal of Thoracic and Cardiovascular Surgery 2001 121, 552-560DOI: (10.1067/mtc.2001.112534) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 In the presence of coronary intussusception (type C), the coronary artery is transected in a nondiseased zone (A) and saphenous vein reconstruction of the vessel is performed with an end-to-end anastomosis (B). The repaired artery is then anastomosed to the aortic graft (C). The Journal of Thoracic and Cardiovascular Surgery 2001 121, 552-560DOI: (10.1067/mtc.2001.112534) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions