Open AccessThe usefulness of a multimodality approach in a case of subtle iatrogenic aortic dissection: Sometimes is better to look and wait
Author(s) -
Ignazio Salamone,
Maria Ludovica Carerj,
Ugo Barbaro,
Vittorio Virga,
Concetta Zito,
A Bracco,
Alfredo Blandino,
Sergio Racchiusa
Publication year - 2019
Publication title -
journal of cardiovascular echography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.255
H-Index - 8
eISSN - 2347-193X
pISSN - 2211-4122
DOI - 10.4103/jcecho.jcecho_13_19
Subject(s) - medicine , ostium , aortic dissection , dissection (medical) , radiology , right coronary artery , ascending aorta , hematoma , myocardial infarction , chest pain , cardiology , surgery , aorta , coronary angiography
We report a rare case of iatrogenic right coronary artery (RCA) dissection complicated by a retrograde subtle aortic dissection, which occurred during a primary percutaneous transluminal coronary angioplasty (PTCA). A 65-year-old female, with acute anterior ST-elevation myocardial infarction (STEMI), promptly underwent primary PTCA in the left anterior descending artery. After 5 h, the patient's condition becomes worse with recurrence of chest pain and new electrocardiogram modifications suggestive of inferior STEMI. A second coronary angiography revealed a spiral dissection extending from the ostium to the medium tract of the RCA. At the same time, a contrast media extravasation due to coronary ostium fissure occurred. Coronary stents were implanted from the medium tract of the right coronary to the ostium, to promptly arrest the active bleeding and to treat the dissection. After cardiosurgical advice, the patient was referred to the radiology department, where she underwent computed tomography angiography (CTA), which showed a small hematoma in the anterior wall of the ascending aorta. The stable clinical conditions of the patient suggested a conservative therapeutic approach. During the following 6 weeks CTA and transesophageal echocardiography were performed to rule out any other complication, and the patient was fortunately discharged with almost complete resolution of the hematoma.