Unusual Complication of Retrograde Dissection to the Coronary Sinus of Valsalva During Percutaneous Revascularization : A Single-Center Experience and Literature Review

摘要

Background: While coronary dissection, which is one of the most frequently occurring compli-ncations during interventional procedures, has various forms, extensive coronary dissectionnretrograde to the coronary sinus of Valsalva (CSV) is very rarely observed.nMethods and results: Within the last 5 years, we retrospectively reviewed our experience withn4,700 consecutive patients who underwent angioplasty procedures, 7 of whom (0.15%) developednextensive coronary dissection retrograde to the CSV. Six of the seven patients developednretrograde dissection of the right CSV during angioplasty to the right coronary artery. One of thenseven patents developed retrograde dissection of the left CSV during angioplasty to the leftnanterior descending artery. Retrograde dissection, which extended to the ascending aorta in twonpatients, was observed by transthoracic echocardiography and surgical findings, respectively.nFive patients were successfully treated by coronary stenting. However, this complication causednfour patients to have acute myocardial infarctions, resulting in emergency surgery for one patientnand in-hospital death for another.nConclusions: Our experience increased our understanding of this very rare complication.nHowever, this complication may be life threatening, and patients in this clinical setting may havena potential risk for acute myocardial infarction, emergency surgery, or even sudden cardiacndeath. Therefore, it is important to learn how to promptly diagnose and manage thisncomplication. (CHEST 2001; 119:493–501)