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Percutaneous Management of Iatrogenic Aortocoronary Dissection Complicating Diagnostic Angiography or Percutaneous Coronary Intervention

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      Iatrogenic coronary artery dissections extending into and involving the aortic root.

      We set out to determine the incidence of iatrogenic coronary artery dissection extending into the aorta and to characterize the aortic lesions. We reviewed the data from 43,143 cardiac catheterizations from September 1993 through September 1999 and found 9 coronary artery-aortic dissections for an overall incidence of 0.02%. Four of these patients were undergoing treatment for acute myocardial infarction (AMI) and aortic dissection was more common than for non-AMI patients (0.19% vs. 0.01%, P 40 mm from the coronary os required surgical intervention.
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        Dissection of the aortic sinus of Valsalva complicating coronary catheterization: cause, mechanism, evolution, and management.

        We have rarely observed the appearance of a dissection of the aortic sinus of Valsalva during catheterizations of the related coronary artery. The aim of this study is to describe the cause, mechanism, and evolution of this complication, which have implications for the management of the patient. According to our experience (one case out of 12,546 diagnostic and three cases out of 4,970 angioplasty procedures performed during the last 6 years), the dissection of the sinus of Valsalva always results from the retrograde extension of a dissection of the right coronary artery. It usually remains localized, but it may quickly involve the entire aorta. Contrast injections and balloon inflations promote its propagation, so these procedures should be avoided if possible. Instead of angiography, transesophageal echocardiogram is a safe and accurate method for studying its extension and as a follow-up method. The sinus of Valsalva dissections that remain localized during catheterization tend to spontaneously resolve in the first month.
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          Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures.

          Aortic dissection type A is a disease with high mortality. Iatrogenic aortic dissection after interventional procedures is infrequent, and prognostic data are scarce. Our objective was to analyze its incidence, patient profile, and long-term prognosis.

            Author and article information

            Department of Cardiology - The Second Xiangya Hospital of Central South University, Changsha, China
            Author notes
            Mailing Address: Zhen-fei Fang, Department of Cardiology, The Second Xiangya Hospital of Central South University, Nº.139, Middle Ren-min Road, Changsha, Hunan, 410011, China. E-mail: fangzhenfei2012@
            Arq Bras Cardiol
            Arq. Bras. Cardiol
            Arquivos Brasileiros de Cardiologia
            Sociedade Brasileira de Cardiologia - SBC
            September 2017
            September 2017
            : 109
            : 3
            : 259-263

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Funded by: The Yu-Ying Plan of the Central South University
            Award ID: 502034007


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