Background: 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.
Methods and results: 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.
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.