Simultaneous Right and Left Coronary Occlusion Caused by an Extensive Dissection to the Coronary Sinus of Valsalva During Percutaneous Intervention in Right Coronary Artery

Abstract

SummaryWe report a case of simultaneous right and left coronary occlusion during percutaneous coronary intervention in the right coronary artery. An aortocoronary dissection induced by the forceful manipulation extended from the right to left sinus of Valsalva and occluded the ostia of both coronary arteries. The patient suffered cardiogenic shock and ventricular fibrillation. However, after successful rapid stenting to right and left coronary arteries, safe discharge was possible. (Int Heart J 2009; 50: 663-667)

Emergency valve preserving ascending aorta replacement following iatrogenic right coronary artery dissection: A life‐saving procedure

“…IACD complicating coronary interventions is extremely rare and a few cases have been reported. The rapid propagation of aortocoronary dissection may become immediately life‐threatening via several sequelae, including hemorrhage into the pericardium resulting in cardiac tamponade, occlusion of the contralateral coronary ostium or propagation of the dissection into the descending aorta 5 . The RCA is more easily dissected in the retrograde direction into the coronary sinus than the left main coronary artery (LMCA) because of the presence of more smooth muscle cells and a dense matrix of collagen type I fibers 6 in the periostial wall and sinotubular junction of the LMCA.…”

Percutaneous Management of Iatrogenic Aortocoronary Dissection Complicating Diagnostic Angiography or Percutaneous Coronary Intervention

“… 2 - 5 The rapid propagation of aortocoronary dissection may become immediately life threatening via several mechanisms, including hemorrhage into the pericardium resulting in cardiac tamponade, occlusion of the contralateral coronary ostium, or propagation of the dissection into the descending aorta. 6 , 7 Most reported iatrogenic aortocoronary dissections have been related to procedures in the RCA, especially during PCI for chronic total occlusions. 2 The RCA is more easily dissected retrogradely into the coronary sinus than the left main coronary artery (LMCA).…”

Right coronary artery perforation extending to the coronary sinus of Valsalva during percutaneous intervention successfully sealed with polytetrafluoroethylene-covered stent: a case report

“…Despite its infrequent incidence, aorto-coronary dissection involving the sinus of Valsalva is potentially catastrophic, leading to devastating consequences [ 3 – 6 , 11 , 13 , 20 , 21 , 27 ]. The first case of aortic dissection as a complication of PCI was described by Moles et al [ 4 ].…”

“…With the advent of PCI and stenting, the mechanisms for iatrogenic perforation are being attributed to: aggressive manipulation of rigid wires into subendothelial spaces, when attempting to re-canalise tight lesions [ 3 , 11 , 12 , 14 , 16 , 19 , 22 ]; forceful manipulation of guiding catheters that are either wedged [ 17 ] or in a non-coaxial position relative to the proximal segment of the coronary artery [ 2 – 4 , 6 , 8 , 10 – 15 , 17 , 18 , 20 , 22 , 27 , 28 ]; and prolonged balloon inflations [ 3 , 12 ]. A vigorous manual injections of contrast medium into the subintimal space plays a major role in extending the dissection further, by generating reverse flow proximal to the catheter tip and causing retrograde extension [ 3 , 4 , 8 , 11 , 14 , 15 , 17 – 19 , 21 , 28 ].…”