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Extensive dissection to the coronary sinus of valsalva during percutaneous intervention in right coronary artery-a case report and literature review.

Li L, Cao Y - Clin Med Insights Cardiol (2011)

Bottom Line: Severe retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention (PCI), but life threatening.There is some literature about this complication, but this particular complication has not been previously reported in China.We present a case of coronary artery dissection during a PCI in which progressively extended retrogradely into the sinus of valsalva, and was successfully treated with stenting without an operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, People's Hospital of Gansu Province, Lanzhou 730000, P.R. China.

ABSTRACT
Severe retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention (PCI), but life threatening. There is some literature about this complication, but this particular complication has not been previously reported in China. We present a case of coronary artery dissection during a PCI in which progressively extended retrogradely into the sinus of valsalva, and was successfully treated with stenting without an operation.

No MeSH data available.


Related in: MedlinePlus

Dissection of the right sinus of Valsalva (Red arrow). Contrast staining limited to the right sinus of Valsalva.
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f3-cmc-2011-041: Dissection of the right sinus of Valsalva (Red arrow). Contrast staining limited to the right sinus of Valsalva.

Mentions: A 63-year-old man with severe unstable angina and aorta sclerosis, who had no primary hypertension and diabetes malleus, was admitted to our hospital to undergo a diagnostic coronary angiography. The procedure was performed from the radial approach and showed presence of three vessels with coronary artery disease (CAD) with severe stenosis of the proximal-mid left anterior descends (LAD) and of the proximal circumflex (CX) coronary arteries and with a chronic total occlusion of the proximal right coronary artery (RCA) (Fig. 1). He was already on treatment with aspirin, clopidogrel and anti-ischemia medicines. Immediately after the angiogram a percutaneous coronary intervention (PCI) of the RCA was planned. The RCA was easily cannulated with a soft tipped 6-French JR4 guiding catheter (USA) having a 0.064 inch inner diameter. After the selection of the guiding catheter in the RCA, an 0.014 inch Pilot 150 guidewire (USA) was advanced to cross the occlusion. After low pressure preinflation in mid segment, we found that a coronary artery dissection had developed at the distal stenotic lesion (Fig. 2) and the patient had stable conditions. The lesion and dissection in the distal RCA was successfully treated with a 3.0 × 24 mm EXCEL eleuting stent. After EXCEL eluting stenting (3.5 × 24 mm) of the lesion in the mid RCA, a contrast injection revealed spiral dissection of proximal RCA which retrogradely extended into the right sinus of Valsalva (Fig. 3). The Electrocardiogram did not show any sign of ischemia, and the patient had no discomfort. He was hemodynamically stable. A 4.0 × 24 mm EXCEL eluiting stent was then immediately placed in proximal overlap with the previous stent, and a second 4.0 × 12 mm EXCEL eluiting stent was deployed in proximal overlap in the RCA to obtain complete coverage of the ostium of RCA resulting in restoration of TIMI 3 flow. To optimize the result, a final post-dilatation was performed in RCA with a 4.0 × 12 mm stent balloon at 16 ATM. A control angiogram showed complete sealing of the coronary dissection and minimal contrast staining limited to the right sinus of Valsalva. Following successful PCI of the RCA, coronary angiography revealed TIMI III coronary blood flow and no dye retention in the right sinus of Valsalva in 30 minutes. Because of lack of chest pain and of signs of ischemia on the electrocardiogram and absence of further aortic involvement, the procedure was concluded and the patient was sent to the coronary care unit for further monitoring. With routine treatment including beta-blockade and low molecule weight heparin etc, the patient remained in the hospital for seven additional days and he was then discharged without any further event. A coronary artery angiography, performed three months later, showed complete resolve of right sinus of Valsalva dissection and no restenosis in RCA (Fig. 4). Meanwhile, we successfully performed PCI in another two vessels.


Extensive dissection to the coronary sinus of valsalva during percutaneous intervention in right coronary artery-a case report and literature review.

Li L, Cao Y - Clin Med Insights Cardiol (2011)

Dissection of the right sinus of Valsalva (Red arrow). Contrast staining limited to the right sinus of Valsalva.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3091417&req=5

f3-cmc-2011-041: Dissection of the right sinus of Valsalva (Red arrow). Contrast staining limited to the right sinus of Valsalva.
Mentions: A 63-year-old man with severe unstable angina and aorta sclerosis, who had no primary hypertension and diabetes malleus, was admitted to our hospital to undergo a diagnostic coronary angiography. The procedure was performed from the radial approach and showed presence of three vessels with coronary artery disease (CAD) with severe stenosis of the proximal-mid left anterior descends (LAD) and of the proximal circumflex (CX) coronary arteries and with a chronic total occlusion of the proximal right coronary artery (RCA) (Fig. 1). He was already on treatment with aspirin, clopidogrel and anti-ischemia medicines. Immediately after the angiogram a percutaneous coronary intervention (PCI) of the RCA was planned. The RCA was easily cannulated with a soft tipped 6-French JR4 guiding catheter (USA) having a 0.064 inch inner diameter. After the selection of the guiding catheter in the RCA, an 0.014 inch Pilot 150 guidewire (USA) was advanced to cross the occlusion. After low pressure preinflation in mid segment, we found that a coronary artery dissection had developed at the distal stenotic lesion (Fig. 2) and the patient had stable conditions. The lesion and dissection in the distal RCA was successfully treated with a 3.0 × 24 mm EXCEL eleuting stent. After EXCEL eluting stenting (3.5 × 24 mm) of the lesion in the mid RCA, a contrast injection revealed spiral dissection of proximal RCA which retrogradely extended into the right sinus of Valsalva (Fig. 3). The Electrocardiogram did not show any sign of ischemia, and the patient had no discomfort. He was hemodynamically stable. A 4.0 × 24 mm EXCEL eluiting stent was then immediately placed in proximal overlap with the previous stent, and a second 4.0 × 12 mm EXCEL eluiting stent was deployed in proximal overlap in the RCA to obtain complete coverage of the ostium of RCA resulting in restoration of TIMI 3 flow. To optimize the result, a final post-dilatation was performed in RCA with a 4.0 × 12 mm stent balloon at 16 ATM. A control angiogram showed complete sealing of the coronary dissection and minimal contrast staining limited to the right sinus of Valsalva. Following successful PCI of the RCA, coronary angiography revealed TIMI III coronary blood flow and no dye retention in the right sinus of Valsalva in 30 minutes. Because of lack of chest pain and of signs of ischemia on the electrocardiogram and absence of further aortic involvement, the procedure was concluded and the patient was sent to the coronary care unit for further monitoring. With routine treatment including beta-blockade and low molecule weight heparin etc, the patient remained in the hospital for seven additional days and he was then discharged without any further event. A coronary artery angiography, performed three months later, showed complete resolve of right sinus of Valsalva dissection and no restenosis in RCA (Fig. 4). Meanwhile, we successfully performed PCI in another two vessels.

Bottom Line: Severe retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention (PCI), but life threatening.There is some literature about this complication, but this particular complication has not been previously reported in China.We present a case of coronary artery dissection during a PCI in which progressively extended retrogradely into the sinus of valsalva, and was successfully treated with stenting without an operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, People's Hospital of Gansu Province, Lanzhou 730000, P.R. China.

ABSTRACT
Severe retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention (PCI), but life threatening. There is some literature about this complication, but this particular complication has not been previously reported in China. We present a case of coronary artery dissection during a PCI in which progressively extended retrogradely into the sinus of valsalva, and was successfully treated with stenting without an operation.

No MeSH data available.


Related in: MedlinePlus