title: Iatrogenic left main-stem dissection extending to the circumflex artery and retrogradely involving the left and non-coronary sinuses of Valsalva: iatrogenic aortocoronary dissection.
abstract: We present the case of a 57-year-old female who experienced iatrogenic left main-stem (LMS) dissection during elective coronary angiography. The dissection immediately affected the circumflex artery (Cx), causing its total distal occlusion, and the left anterior descending artery (LAD), in which a metal stent, implanted six months earlier, provided blood flow. The dissection spread retrogradely to the left and non-coronary sinuses of Valsalva (SV). Ventricular fibrillation (VF) occurred but the patient was successfully defibrillated. The subsequent introduction of a catheter resulted in recurrent VF, again successfully defibrillated. Total arterial myocardial revascularisation with double skeletonised internal thoracic arteries was performed without complications and SV repair was avoided. At the one-year follow up, a control multi-slice CT (MSCT) angiography was conducted, revealing complete healing of the SV and LMS dissections. It also showed native blood flow, the left internal thoracic artery (LITA) graft to the Cx occlusion, and a patent right internal thoracic artery (RITA) graft implanted to the LAD.
authors.affiliation: Department of Cardiac Surgery, Clinical Teaching Centre, Medical University of Lodz, Lodz, Poland.
authors.forename: Radosław
authors.initials: R
authors.lastname: Zwoliński
authors.affiliation: Department of Cardiac Surgery, Clinical Teaching Centre, Medical University of Lodz, Lodz, Poland. annamar87@o2.pl.
authors.forename: Anna
authors.initials: A
authors.lastname: Marcinkiewicz
authors.affiliation: Department of Radiology: Imaging Diagnostics, Norbert Barlicki Memorial Teaching Hospital No 1, Medical University of Lodz, Lodz, Poland.
authors.forename: Konrad
authors.initials: K
authors.lastname: Szymczyk
authors.affiliation: Department of Vascular Diagnostics and Procedures, Military Teaching Hospital, Veterans Central Hospital, Lodz, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Pietruszyński
authors.affiliation: Department of Cardiac Surgery, Clinical Teaching Centre, Medical University of Lodz, Lodz, Poland.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Jaszewski
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007387:Internal Mammary-Coronary Artery Anastomosis; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology