Iatrogenic dissection of the ascending aorta following heart catheterisation: incidence, management and outcome.
OBJECTIVE
Iatrogenic ascending aorta dissection (AAD) is an uncommon complication following heart catheterisation. AIMS of this study were to determine the incidence, to identify the predisposing procedural factors and to define the management and the outcomes of patients suffering from iatrogenic AD.


RESULTS
Between January 1996 and May 2005, iatrogenic AAD that occurred during cardiac catheterisations, were retrospectively identified from clinical and peri-procedural data prospectively collected in a dedicated database. At least 1-month clinical follow-up (median 25 months; range 5-77) was obtained in all patients complicated with iatrogenic AD. The overall incidence of iatrogenic AAD was 0.04%; this incidence was significantly higher after interventional procedures (0.12%) than after diagnostic procedures (0.01%; p=0.0001). Most of dissections were located in the right coronary sinus (12 patients; 67%) and limited to the corresponding coronary sinus (Dunning class I: 11 patients; 61%). Manoeuvres most often involved were coronary engagement with the use of non-conventional catheters. Conservative treatment with sealing the entry door by a stent 10 patients (56%) or expectant management 7 patients (39%) resulted in favourable outcomes as none of patients died during hospitalisation and follow-up.


CONCLUSIONS
Iatrogenic AAD is a rare complication following cardiac catheterisation that in the vast majority of patients may benefit from conservative treatment with good long-term outcomes.
Gómez-Moreno
Silvia
S
Interventional Cardiology Department, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
Sabaté
Manel
M
Jiménez-Quevedo
Pilar
P
Vázquez
Paul
P
Alfonso
Fernando
F
Angiolillo
Dominick J
DJ
Hernández-Antolín
Rosana
R
Moreno
Raúl
R
Bañuelos
Camino
C
Escaned
Javier
J
Macaya
Carlos
C