Stanford type A acuteaortic dissection associated with aircraft depressurization: Cause or coincidence? Mauer A.A. Gonçalves1,2; Humberto Morais2,3; Valdano Manuel4; Fernando Coelho1, Sheila Nunes1, Fernando Flora1.1Luanda Medical Center, Angola;2Centro de Estudos Avançados em Educação e Formação Médica, Faculdadede Medicina, Agostinho Neto University, Luanda, Angola3Hospital militar Principal/Instituto Superior4Centro cardiotorácico, Hospital de Doenças Cardiopulmonares Don Alexandre do NascimentoCorresponding Author: *Humberto Morais – Hospital Militar Principal/Instituto Superior,Rua Pedro Miranda 40-42 Maianga Luanda Republic of AngolaEmail: [email protected] Telephone: +244923520937We declare that the patient approved the study by signing an informed consent form and the study followed the ethical guidelines established by the Declaration of Helsinki.

During the COVID-19 pandemic, many specialists doctors found themselves in a situation that they had not faced for a long time: treating patients out of their subarea of expertise. The possibilities of teaching and learning through the modalities of webinars brought to these days the urgent necessity for teamwork and interdisciplinary approach, taking advantage of different areas of expertise to the same patient. With the amount of papers published and the speed at which data are accessed, and analyzed it is impossible to be aware of new findings in all medical areas. The lesson that the COVID-19 pandemic brought to us was the urgent need for the interdisciplinary approach to treating better our patients, and not only each disease they present with. We must review our traditional approach to medical students, residents, colleagues, and patients in which we became stuck to distance and time obstacles. We must use the technology on our behalf to offer the best treatment and follow-up for patients. We live now in the Medicine 4.0 era. As Darwin a long time ago proved: we must evolve!

In December 2019, the novel coronavirus disease 2019 (COVID-19) emerged in China and spread rapidly around the world, resulting in a pandemic declared by the World Health Organization in March 2020. The disease has affected more than 11 million people in Brazil, with more than 265.000 deaths to date, as we are now facing a second wave of infections. Regarding medical assistance and training, it turned out to be a great challenge, since - among other things - many residents were relocated to respiratory units to treat patients with COVID-19. Even though the residency programs situation has become chaotic all around the world and the activities in almost all specialties nearly stopped (especially in surgical specialties), the need to reinvent the way of teaching was the best concern. Worldwide the “webinars fever” was an impulse to try new strategies to fulfill the gaps of knowledge of these future specialists. It is crucial to call to the responsibility put on medical training institutions to prepare these new professionals according the principles of evidence-based medicine, surgical proficiency and patient safety.

Anomalous Aortic Origin of Coronary Artery (AAOCA) is a rare finding, with varied presentation and symptomatology. Increasingly recognized by cardiac imaging, when found it raises questions about the appropriate approach and management. We present a case of an 11-year-old female who presented with episodes of shortness of breath, angina and syncope during exercise. Further investigation demonstrated episodes of nonsustained ventricular tachycardia on Holter and coronary angiotomography revealed that the left coronary artery had an anomalous origin from the right cusp with initial short intramural segment and significant external compression in its initial course between the aorta and the pulmonary artery. Patient was submitted to surgical correction with dissection of left coronary artery posterior to the pulmonary artery, coronary arteriotomy, roof ampliation with autologous pericardium and creation of neo-ostium in aorta. Patient had satisfactory postoperative recovery, was discharged on the fifth day post op, and remains asymptomatic after six months follow-up. Herein we present surgical video and postoperative echo and CT scan.