Exuberant microvascular dysfunction: An indirect sign of coronary involvement in acute aortic syndrome?

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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "395" "paginaFinal" => "397" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Margarida Cabral, Hélia Martins, Beatriz Santos, Pedro Jerónimo de Sousa, João Morais" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Margarida" "apellidos" => "Cabral" "email" => array:1 [ 0 => "anamargaridacabral@outlook.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Hélia" "apellidos" => "Martins" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Beatriz" "apellidos" => "Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Pedro Jerónimo de" "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "João" "apellidos" => "Morais" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Cardiology Department, Leiria Hospital Centre, Leiria, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "ciTechCare (Centre for Innovative Care and Health Technology), Polytechnique, Leiria, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Disfunção microvascular exuberante: um sinal indireto de envolvimento coronário na síndrome aórtica aguda?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 805 "Ancho" => 805 "Tamanyo" => 85208 ] ] "descripcion" => array:1 [ "en" => "Clip 2. Aortography. Aortography showing an intimal flap in the ascending aorta (green arrow). AA: ascending aorta." ] ] ] "textoCompleto" => "A 75-year-old obese woman with dyslipidemia and hypertension was admitted for acute chest pain. She presented anterolateral ST-segment elevation (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>) and slightly elevated troponin levels. She was transferred to a percutaneous coronary intervention-capable centre.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>On admission, she presented with cardiogenic shock. Cardiac catheterization showed a dubious image of left main coronary artery dissection, without atherosclerotic lesions. An extremely slow flow in the left anterior descending and left circumflex arteries was noted (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A, Clip 1A), concomitant with contrast retention in the myocardial microcirculation (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B, Clip 1B).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Aortography revealed a subtraction image compatible with an intimal flap in the ascending aorta (AA) (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>, Clip 2), suggestive of aortic dissection (AD). The transthoracic echocardiogram revealed moderate left ventricular systolic dysfunction with anterior wall and apex hypokinesia, with no valvular changes.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Computed tomography showed myocardial contrast retention in the left ventricle wall (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>A). An aneurysmal dilatation of the AA with associated intramural hematoma and an intimal flap extending distally were noted, compatible with Stanford type A AD (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>B and C). She suffered a cardiac arrest with pulseless electrical activity, recovered after 12 minutes of advanced life support, and was transferred to a cardiothoracic surgery centre. On admission to this center, she presented echocardiographic signs of retrograde dissection, with aortic regurgitation, and no clinical conditions for performing surgery. The patient died a few hours later.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>This case portrays a poorly known phenomenon of myocardial contrast retention that should alert clinicians to a possible coronary artery involvement in the context of acute aortic syndrome.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-03-22" "fechaAceptado" => "2022-07-11" "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 469 "Ancho" => 1505 "Tamanyo" => 147504 ] ] "descripcion" => array:1 [ "en" => "Admission 12-lead electrocardiogram. Twelve-lead electrocardiogram showing sinus rhythm and anterolateral ST-segment elevation." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 669 "Ancho" => 1340 "Tamanyo" => 114157 ] ] "descripcion" => array:1 [ "en" => "A/Clip 1A. Cardiac catheterization. Left heart catheterization showing slow flow in the left main coronary artery and its branches. B/Clip 1B. Cardiac catheterization. Left heart catheterization showing myocardial microcirculation contrast retention. LAD: left anterior descending coronary artery; LCx: left circumflex coronary artery; LM: left main coronary artery; LV: left ventricle." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 805 "Ancho" => 805 "Tamanyo" => 85208 ] ] "descripcion" => array:1 [ "en" => "Clip 2. Aortography. Aortography showing an intimal flap in the ascending aorta (green arrow). AA: ascending aorta." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3340 "Ancho" => 784 "Tamanyo" => 285388 ] ] "descripcion" => array:1 [ "en" => "(A) Coronal computed tomography. Non-contrast-enhanced coronal computed tomography showing myocardial contrast retention in the left ventricle wall (red arrow). (B) Coronal computed tomography. Contrast-enhanced coronal computed tomography showing intramural hematoma in ascending aorta (blue arrow). (C). Axial computed tomography. Contrast-enhanced axial computed tomography showing intramural hematoma in descending aorta (red arrow). AA: ascending aorta; LV: left ventricle." ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004200000004/v2_202304070551/S0870255123001051/v2_202304070551/en/main.assets" "Apartado" => array:4 [ "identificador" => "93366" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Images in Cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004200000004/v2_202304070551/S0870255123001051/v2_202304070551/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123001051?idApp=UINPBA00004E"]