Iatrogenic left main-stem dissection extending to the circumflex artery and retrogradely involving the left and non-coronary sinuses of Valsalva: iatrogenic aortocoronary dissection

Cardiovasc J Afr. 2015 Nov 23;26(6):e5-7. doi: 10.5830/CVJA-2015-060.

Abstract

We present the case of a 57-year-old female who experienced iatrogenic left main-stem (LMS) dissection during elective coronary angiography. The dissection immediately affected the circumflex artery (Cx), causing its total distal occlusion, and the left anterior descending artery (LAD), in which a metal stent, implanted six months earlier, provided blood flow. The dissection spread retrogradely to the left and non-coronary sinuses of Valsalva (SV). Ventricular fibrillation (VF) occurred but the patient was successfully defibrillated. The subsequent introduction of a catheter resulted in recurrent VF, again successfully defibrillated. Total arterial myocardial revascularisation with double skeletonised internal thoracic arteries was performed without complications and SV repair was avoided. At the one-year follow up, a control multi-slice CT (MSCT) angiography was conducted, revealing complete healing of the SV and LMS dissections. It also showed native blood flow, the left internal thoracic artery (LITA) graft to the Cx occlusion, and a patent right internal thoracic artery (RITA) graft implanted to the LAD.

Publication types

  • Case Reports

MeSH terms

  • Aortic Aneurysm / diagnostic imaging
  • Aortic Aneurysm / etiology*
  • Aortic Aneurysm / surgery
  • Aortic Dissection / diagnostic imaging
  • Aortic Dissection / etiology*
  • Aortic Dissection / surgery
  • Aortography / methods
  • Blood Vessel Prosthesis Implantation
  • Cardiac Catheterization / adverse effects*
  • Coronary Aneurysm / diagnostic imaging
  • Coronary Aneurysm / etiology*
  • Coronary Aneurysm / surgery
  • Coronary Angiography / adverse effects*
  • Coronary Angiography / methods
  • Female
  • Humans
  • Iatrogenic Disease*
  • Internal Mammary-Coronary Artery Anastomosis
  • Middle Aged
  • Multidetector Computed Tomography
  • Sinus of Valsalva / diagnostic imaging
  • Sinus of Valsalva / injuries*
  • Sinus of Valsalva / surgery
  • Treatment Outcome
  • Ventricular Fibrillation / etiology