Aorto-coronary dissection during angioplasty in a patient with myxedema.
A 67-year-old man with overt hypothyroidism and medically controlled hypertension was admitted for coronary angiography because of exertional angina. His triiodothyronine (T3) and thyroxine (T4) levels had been low for 4 years. Although signs and symptoms of hypothyroidism were apparent, his hypercholesterolemia was mild. Coronary angiography revealed an eccentric stenosis in the distal portion of the right coronary artery and it was decided to perform angioplasty because his angina had continued in spite of medication. The dissection appeared at the lesion site after the first nominal inflation, and a subsequent image disclosed a spiral dissection from the dilated site to the aortic sinus and peripheral coronary artery. Although emergency stenting could not prevent the extension near the origin of the brachiocephalic artery, the false lumen thrombosed and then diminished with conservative therapy. Aorto-coronary dissection is potentially life-threatening and has been recently reported as a complication during cardiac catheterization procedures. Chronic hypothyroid insufficiency may be one of the risk factors for this complication.
Okamoto
R
R
First Department of Internal Medicine, Mie University, Tsu, Japan. ryuji@clin.medic.mie-u.ac.jp
Makino
K
K
Saito
K
K
Miyahara
M
M
Okamoto
S
S
Kouji
T
T
Isaka
N
N
Nakano
T
T
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000209:etiology; D017130:Angioplasty / Q000009:adverse effects*; D001014:Aortic Aneurysm / Q000209:etiology*; D003323:Coronary Aneurysm / Q000209:etiology*; D004210:Dissection; D006111:Graves Disease; D006801:Humans; D007037:Hypothyroidism / Q000150:complications*; D008297:Male; D009230:Myxedema / Q000150:complications*