Project description:Iatrogenic left main coronary artery and aortic root dissection is a rare but life-threatening complication of percutaneous coronary intervention. This is a case where this complication was induced by catheter manipulation. Prompt percutaneous closure of the dissection point of entry was effective in managing this complication. (Level of Difficulty: Advanced.).
Project description:Coronary angiography of high take-off right coronary artery (RCA) arising from ascending aorta under percutaneous cardiopulmonary support may be more effective at the site distal to RCA ostium rather than proximal. Guide extension catheters (GECs) may be useful to strengthen backup of percutaneous coronary interventions (PCI) system and to contrast coronary lesions clearly during PCI of these RCAs.
Project description:BackgroundAscending aorta replacement can be performed safely in high-volume centers. What remains unknown is whether concomitant coronary revascularization with bypass grafting affects postoperative outcomes.MethodsThis study retrospectively reviewed a prospectively maintained institutional database for patients who underwent ascending aorta replacement (AAR) during the period from 1997 to 2018. Patients were stratified into AAR alone (AAR) vs AAR and coronary artery bypass graft (AAR with CABG), further categorized as 1 or more than 1 CABG. Aortic dissection and root replacement cases were excluded. The primary end point consisted of major adverse events (MAE), including operative mortality, perioperative myocardial infarction, stroke, need for tracheostomy, and need for dialysis. Secondary end points were operative mortality, each MAE component, and late survival.ResultsA total of 951 patients were included in the analysis; 725 (76.2%) underwent isolated AAR, and 226 (23.8%) underwent AAR with CABG. Operative mortality was similar across the 2 groups (1.8% for AAR with CABG and 0.8% for AAR; P = .40). The unadjusted incidence of MAE was higher in the AAR with CABG group (5.8% vs 1.9%; P = .005).). On multivariable analysis, the performance of 1 CABG (odds ratio [OR], 1.90; 95% confidence interval [CI], 0.67 to 5.33; P = .23) and more than 1 CABG (OR, 2.65; 95% CI, 0.93 to 7.53; P = .07) was not associated with higher rates of MAE. Preoperative pulmonary dysfunction (OR, 2.51; 95% CI, 1.07 to 5.85; P = .03) was the only independent predictor of MAE.ConclusionsIn patients undergoing concomitant CABG with AAR, the performance of concomitant CABG is not associated with an increased risk of MAE.
Project description:Iatrogenic acute dissection of ascending aorta following coronary angiography and percutaneous intervention is a rare complication. Most reports involve localized aortic dissections as a complication of cannulation of a coronary artery with propagation into the ascending aorta. It is usually treated by sealing the intima with a stent in the ostium of the coronary artery or conservative management, while extensive dissections may require a surgical intervention. We describe a case of the subclavian dissection extending into the ascending aorta that occurred during diagnostic catheterization using the radial approach. The patient was successfully treated utilizing conservative management.
Project description:BackgroundLeft main coronary artery (LMCA)-acute coronary syndrome (ACS) is a rare complication of a floating thrombus in the ascending aorta. However, diagnosing the aetiology of LMCA-ACS during an emergency situation is challenging. We present a rare case of LMCA-ACS caused by a large thrombus in the ascending aorta, confirmed by intravascular ultrasound (IVUS).Case summaryA 90-year-old woman presented to the emergency department complaining of chest pain and syncope. On admission, her electrocardiogram showed normal sinus rhythm and a complete right bundle branch block with significant ST depression in the V3-V6 leads; hence, ACS was suspected. The first emergency angiogram of the left coronary artery showed filling defect in the proximal ascending aorta. IVUS revealed a large thrombus in the ascending aorta. The thrombus extended from the ascending aorta to the proximal left anterior descending coronary artery. IVUS confirmed that there was no dissection of the coronary artery or the proximal ascending aorta. Based on the IVUS findings, this case was diagnosed as ACS of the LMCA caused by a floating thrombus in the ascending aorta.DiscussionThis rare case of LMCA-ACS caused by a thrombus in the ascending aorta was confirmed by IVUS, which can be a useful imaging tool for diagnosing morphological abnormalities during emergencies.
Project description:A 53-year-old woman, nonsmoking patient, with a history of surgically corrected anomalous origin of the right coronary artery from the pulmonary artery 17 years prior to admission, presented to our department complaining of mild, left-sided exertional chest pain for the past 3 months. She underwent a computed tomography examination of the heart and coronary angiography revealing postsurgical changes to the coronary vasculature and severe stenosis of the left circumflex artery, which was successfully treated by percutaneous stent implantation.
Project description:Background:Anomalous left coronary artery from pulmonary artery (ALCAPA) is a rare coronary abnormality. Although it exists usually as an isolated abnormality, ALCAPA has been described with aortic pathologies like coarctation or aortopulmonary window. Case summary:An 18-day-old female was admitted to the paediatric intensive care unit because of a heart murmur and weak femoral pulses. A transthoracic two-dimensional echocardiography was performed and confirmed suspected diagnosis of aortic coarctation. In addition, a total retrograde perfusion of the left circumflex coronary artery (LCX) was found, without visible flow through the ostium of the left coronary artery (LCA) into the aorta. A coronary angiography was performed, showing a single right coronary artery with a normal right posterior descending artery (RPD). Supplied by collaterals from the RPD, the LCX was perfused retrogradely, passing by the lateral wall of the ascending aorta without flowing into it, but into the right pulmonary artery. At 23?days of age, surgery was performed with resection of the aortic coarctation and reimplantation of the LCA into the posterior aortic wall. Discussion:This case demonstrates that coronary artery anomalies like ALCAPA may occur together with other cardiac malformations. Despite concomitant cardiac lesions, careful assessment of the coronary arteries is mandatory, including cardiac catheterization in case of doubt.
Project description:Hyperprolactinemia is a risk factor for thrombus formation. We present a rare case of a mobile ascending aorta thrombus leading to acute myocardial infarction and cerebral infarction in a patient with idiopathic hyperprolactinemia. (Level of Difficulty: Beginner.).
Project description:Dissection of the ascending aorta is a very rare but life-threatening complication during diagnostic angiography. We present a case of an elderly woman who underwent an elective diagnostic coronary angiography, complicated with an iatrogenic ascending aorta dissection that did not involve the coronary arteries but originated 4 cm distal of the aortic valve. The patient developed cardiogenic shock due to acute pericardial tamponade and so immediate, life-saving cardiac surgery with implantation of a supracoronary graft was successfully performed. A biopsy from the excised aorta showed loss of smooth muscle cells and accumulation of basophilic ground substance, clear features of cystic media necrosis. This is believed to be the underlying cause of the dissection besides a nonselective injection of the right coronary artery.
Project description:Dilatation of the ascending aorta (AA) is a common finding in patients with aortic valve disease. The clinical practice guidelines recommend replacing the AA whenever the diameter exceeds 45 mm. However, no consensus has been reached regarding the approach when the aorta is only moderately dilated. Although the risk in aorta replacement is generally low, it may be higher when associated with other complex surgical procedures or it is carried out in elderly patients or patients with significant comorbidity. This would justify the use of alternative surgical techniques, which reduce surgical risk and guarantee a durable correction of the aortic pathology. Conservative treatment of aneurysms of the AA via wrapping with different synthetic materials has been implemented for many years. The most commonly used technical variant is wrapping the dilated aorta with a vascular prosthesis with a predetermined diameter. When this technique is adequately applied, it immediately reduces the diameter of the AA and, to a lesser degree, the diameter of the aortic root and arch, while at the same time it reinforces the weak aortic wall. These effects lead to a drop-in wall shear stress and in the risk of aortic dissection and rupture, and persist over time. Although the low elasticity of the external support causes significant changes in the histologic structure of the aortic wall, mainly atrophy and alterations typical of a foreign body-induced reaction, this does not seem to involve a higher risk of complications. In some selected patients, this technique may be used in cases other than post-stenotic aortopathy, and also in aortas with a larger diameter.