Post-Cardiopulmonary Bypass Surgery with Sequential ECMO Therapy for the Management of Aortic Dissection Complicated with Myocardial Infarction: a case report

Abstract Background Aortic dissection, a critical cardiovascular condition, poses a significantly high risk of mortality. The clinical manifestations associated with myocardial infarction can complicate the diagnosis of aortic dissection, thereby hindering timely and comprehensive treatment administration and aggravating patient prognosis. However, the administration of ECMO therapy postoperatively for aortic dissection has been shown to effectively enhance patient outcomes. Case presentation A 45-year-old male patient presented to our hospital's emergency department complaining of back pain. Upon urgent electrocardiogram examination, he was diagnosed with acute inferior ST-segment elevation myocardial infarction complicated by third-degree atrioventricular block. Promptly, the patient underwent treatment for acute myocardial infarction and was urgently transferred to the interventional catheterization laboratory. Coronary angiography revealed a 60% stenosis in the distal portion of the circumflex artery, attributed to plaque accumulation. Despite the subsequent performance of balloon angioplasty and thrombectomy, the patient's precordial pain persisted. Subsequently, an emergency thoracic aortic computed tomography angiography (CTA) and echocardiography were conducted, revealing the presence of a DeBakey Type I aortic dissection. Prompt action was taken, and the patient was immediately transferred to the cardiac surgery department. There, he underwent an emergency surgical procedure involving cardiopulmonary bypass (CPB) for the replacement of the ascending aorta and aortic sinus. Postoperatively, he was supported with extracorporeal membrane oxygenation (ECMO) and gradually regained consciousness under the intensive care unit's vigilant supervision. Once hemodynamic stability was achieved, ECMO support was discontinued. The patient ultimately recovered and was successfully discharged from the hospital. Conclusion This case underscores that precordial pain is not exclusively confined to myocardial infarction, but may also coexist with aortic dissection. The implementation of ECMO therapy postoperatively can effectively mitigate adverse prognoses stemming from myocardial infarction, cardiopulmonary bypass procedures, prolonged cardiac arrest, and myocardial ischemia-reperfusion injury. Furthermore, individualized treatment holds utmost significance in managing complex aortic dissections.