Acute aortic dissection is a life-threating condition, and myocardial ischemia associated with dissection occurs due to direct extension of coronary artery or indirect involvement of the coronary ostia secondary to dissection flap. In that case, the surgical procedure would require coronary reconstruction in addition to aortic replacement. We have experienced a case in which coronary artery reconstruction could be avoided because intraoperative transesophageal echocardiography showed that the aortic flap unobstructed the right coronary artery in systole, and pulsed Doppler showed that there was sufficient coronary blood flow. It is critical to establish a correct and early diagnosis and to proceed with the correct treatment in patients with clinical and monitoring of myocardial ischemia

Keisuke Sumii graduated from medical school in Japan in 2009, I have worked as an anesthesiologist for 8 years after 2 years of clinical training. I am currently working at a 450-bed acute care hospital in Saitama, Japan, where I am mainly responsible for cardiac anesthesia.