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      Extensive Dissection to the Coronary Sinus of Valsalva During Percutaneous Intervention in Right Coronary Artery—A Case Report and Literature Review

      * ,

      Clinical Medicine Insights. Cardiology

      Libertas Academica

      dissection, sinus of valsalva, complication, PCI, operation

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          Abstract

          Severe retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention (PCI), but life threatening. There is some literature about this complication, but this particular complication has not been previously reported in China. We present a case of coronary artery dissection during a PCI in which progressively extended retrogradely into the sinus of valsalva, and was successfully treated with stenting without an operation.

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          Most cited references 11

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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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            Sinus of Valsalva aneurysms.

             N Goldberg,  N KRASNOW (1990)
            Sinus of Valsalva aneurysms are rare cardiac anomalies which may be acquired or congenital. The congenital aneurysm is more common than the acquired form, with an incidence ranging from 0.1 to 3.5% of all congenital heart defects. Acquired aneurysms may result from trauma, endocarditis, syphilis, Marfan's syndrome, and senile-type dilatation in which the three sinuses dilate as a result of the normal aging process. This review focuses on both congenital and acquired aneurysms with particular attention to the noninvasive diagnosis of this anomaly.
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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.

               K A Yeh,  C. Fang,  R-K Hsieh (2001)
              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. 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. 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.
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                Author and article information

                Journal
                Clin Med Insights Cardiol
                101466475
                Clinical Medicine Insights. Cardiology
                Libertas Academica
                1179-5468
                2011
                12 April 2011
                : 5
                : 41-44
                Affiliations
                Department of Cardiovascular Medicine, People’s Hospital of Gansu Province, Lanzhou 730000, P.R. China
                Author notes
                [* ]Corresponding author email: lilygs@ 123456126.com
                Article
                cmc-2011-041
                10.4137/CMC.S6447
                3091417
                21573038
                © the author(s), publisher and licensee Libertas Academica Ltd.

                This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.

                Categories
                Case Report

                Cardiovascular Medicine

                operation, dissection, sinus of valsalva, pci, complication

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