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Douglas A. Murphy
Joseph M. Craver
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Ann Thorac Surg 1984;37:473-478
© 1984 The Society of Thoracic Surgeons

Articles

Distal Coronary Artery Dissection Following Percutaneous Transluminal Coronary Angioplasty

Douglas A. Murphy, M.D.*, Joseph M. Craver, M.D., Spencer B. King, III, M.D.

From the Joseph B. Whitehead Department of Surgery and the Department of Medicine, Emory University School of Medicine, Atlanta, GA

Accepted for publication December 12, 1983.

* Address reprint requests to Dr. Murphy, Emory University Clinic, 1365 Clifton Rd, NE, Atlanta, GA 30322

The most common cause of acute myocardial ischemia following percutaneous transluminal coronary angioplasty is coronary dissection, which characteristically remains localized to the site of balloon dilation. In this article, however, we report on 4 patients in whom percutaneous transluminal coronary angioplasty was complicated by coronary artery dissection extending distally beyond the site of anticipated vein graft anastomosis. Intraoperative diagnosis of distal coronary dissection is suggested by a characteristic appearance of the artery and confirmed by the finding of true and false lumens at the time of coronary arteriotomy. Successful revascularization is achieved by anastomosis of a vein graft to the true lumen with reapproximation of the dissected arterial layers. Proximal coronary artery ligation in this setting is unnecessary.




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