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Unusual Complication of Retrograde Dissection to the Coronary Sinus of Valsalva During Percutaneous Revascularization^*

A Single-Center Experience and Literature Review

^* From the Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan, Republic of China.

Correspondence to: Hon-Kan Yip, MD, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 123 Taipei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan, Republic of China

Background: While coronary dissection, which is one of the most frequently occurring complications during interventional procedures, has various forms, extensive coronary dissection retrograde to the coronary sinus of Valsalva (CSV) is very rarely observed.

Methods and results: Within the last 5 years, we retrospectively reviewed our experience with 4,700 consecutive patients who underwent angioplasty procedures, 7 of whom (0.15%) developed extensive coronary dissection retrograde to the CSV. Six of the seven patients developed retrograde dissection of the right CSV during angioplasty to the right coronary artery. One of the seven patents developed retrograde dissection of the left CSV during angioplasty to the left anterior descending artery. Retrograde dissection, which extended to the ascending aorta in two patients, was observed by transthoracic echocardiography and surgical findings, respectively. Five patients were successfully treated by coronary stenting. However, this complication caused four patients to have acute myocardial infarctions, resulting in emergency surgery for one patient and in-hospital death for another.

Conclusions: Our experience increased our understanding of this very rare complication. However, this complication may be life threatening, and patients in this clinical setting may have a potential risk for acute myocardial infarction, emergency surgery, or even sudden cardiac death. Therefore, it is important to learn how to promptly diagnose and manage this complication.

Key Words: aortic dissection • coronary angioplasty • coronary stenting • sinus of Valsalva dissection

This article has been cited by other articles:

				T. M. Patel, S. C. Shah, and A. Ranjan Unusual Retrograde Aortic Arch Dissection During Percutaneous Coronary Intervention: A Case Report Angiology, August 1, 2006; 57(4): 501 - 505. [Abstract] [PDF]

				V. N. Bapat and G. E. Venn A rare case of aortocoronary dissection following percutaneous transluminal coronary angioplasty: successful treatment using off-pump coronary artery bypass grafting Eur. J. Cardiothorac. Surg., August 1, 2003; 24(2): 312 - 314. [Abstract] [Full Text] [PDF]