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Ann Thorac Surg 2009;87:1299. doi:10.1016/j.athoracsur.2008.07.058
© 2009 The Society of Thoracic Surgeons
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Images in Cardiothoracic Surgery

Iatrogenic Type A Aortic Dissection: An Unusual Complication of Percutaneous Transluminal Coronary Angioplasty

Krzysztof Jarmoszewicz, MD, PhD*, Piotr Siondalski, MD, PhD, Lukasz Jaworski, MD, PhD, Jan Rogowski, MD, PhD

Department of Cardiovascular Surgery, Medical University of Gdansk, Gdansk, Poland

* Address correspondence to Dr Jarmoszewicz, Department of Cardiac Surgery, Academy of Medicine, Debinki Str. 7, Gdansk, 80-211, Poland (Email: jarmo{at}amg.gda.pl).

A 70-year-old woman was admitted to hospital due to acute coronary syndrome. A coronary angiogram revealed a totally occluded right coronary artery. A percutaneous transluminal coronary angioplasty with stenting was performed. Unfortunately this procedure was complicated by aortic dissection. Through a median sternotomy the Bentall de Bono procedure was carried out under deep hypothermia and antegrade cerebral perfusion. Perioperative pictures demonstrate the aorta, which is transected at the level of the sinotubular junction. In Figure 1 we can see the circular dissection of the aortic root. The arrow indicates the stent fixed in the right coronary ostium (arrow). In Figure 2 we can see completely dissected intima with the stent fixed in also dissected right coronary ostium. The cloth around the right coronary ostium is clearly visible. During the procedure, this ostium was sewn up and the bypass to the right coronary artery was performed. There were no serious complications after the procedure, and the patient was discharged from the hospital.


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Jan Rogowski
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