title: Iatrogenic dissection of the ascending aorta following heart catheterisation: incidence, management and outcome.
abstract: 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.
authors.affiliation: Interventional Cardiology Department, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gómez-Moreno
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
authors.forename: Pilar
authors.initials: P
authors.lastname: Jiménez-Quevedo
authors.forename: Paul
authors.initials: P
authors.lastname: Vázquez
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.forename: Camino
authors.initials: C
authors.lastname: Bañuelos
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya