Introduction
Acute aortic dissection is the most challenging, life-threatening condition and requires prompt diagnosis and management. However about one-third of patients with type A acute aortic dissection (TAAAD) die within 24 hours, 50% within 48 hours and 95% die within first month. [1] Acute myocardial infarction within the TAAAD is the most fatal situation and occurs in about 1-2% of cases.[2] A total coronary artery avulsion is somewhat rare event in setting of TAAAD specially when it’s asymptomatic. TAAAD occurs at a rate of 3-4 per 100,000 per year [3] and a delay in diagnosis, after symptomatic onset, leads to increase mortality in order of 1% to 2% per hour of misdiagnosed presentation of acute type A aortic dissection.[4] Coronary artery malperfusion has an incidence of 6-19 %. [5-8] In about 25% of patients the acute aortic syndrome occur with acute coronary syndrome ( ACS ) and sometimes is misdiagnosed and treated not propery. [9] Moreover patients with acute coronary involvement have an higher incidence of aortic regurgitation. Together, aortic regurgitation and coronary artery malperfusion may lead to acute ventricular failure.[2,9] The standard approach to treat patients with aortic root and arch dissection remain the open surgical approach by hypothermic circulatory arrest and cerebral perfusion.[10] We report a case of a young patient, treated 3-years ago for acute type B aortic disseection who underwent cardiac surgery for sub-acute type A aortic dissection ( De Backey type I, Stanford type A) and discuss the features of this case.