[Successful surgical treatment in a case of type IIIb acute aortic dissection complicated with acute myocardial infarction].

The patient was a 48-year-old man who was brought to our hospital complaining of chest pain, paresthesia of the lower extremities, and pain in the lumbar region. At first, acute myocardial infarction was diagnosed, but transthoracic echocardiogram revealed an intimal flap in the ascending aorta. The presence of an intimal tear below the left subclavian artery was confirmed by intraoperative transesophageal echocardiogram, and a diagnosis of myocardial infarction accompanying type IIIb aortic dissection with retrograde extension to the ascending aorta was made. Coronary artery bypass grafting to segment #2 using a section of saphenous vein and total aortic arch replacement with "elephant trunk" technique, which concurrently served as a means of amputated stump plasty, was performed. The cerebral circulation was preserved by retrograde cerebral circulation. The post operative progress was good, and thrombo-occlusion of the false lumens of the proximal descending aorta was verified. Type IIIb aortic dissection complicated with myocardial infarction is rare, but examination with both transthoracic and transesophageal echocardiograms were useful for the morphological diagnosis and for determining the surgical technique for the dissection.