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Cardiothoracic Surgery: Cardiothoracic |

Cath Lab Emergency: Management of Procedure-Induced Acute Aortocoronary Dissection FREE TO VIEW

Tsung-Po Tsai, PhD; Jung-Ming Yu, MD; Mao-Jen Lin, MD; Kai-Wei Chang, MD; An-Hua Sun, MBA; Kuei-Chuan Chan, MD; Heng Su, MD; Shih-Chen Tsai, MD; Su-Chin Tsao, NP
Author and Funding Information

Chung Shan Medical University Hospital, Taichung, Taiwan


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A60. doi:10.1016/j.chest.2016.02.063
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Published online

SESSION TITLE: Cardiothoracic

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: Acute aorto-coronary dissection during percutaneous coronary intervention (PCI) is a rare but life-threatening complication. Patients may have a potential risk for dissection-related acute myocardial infarction (AMI), acute aortic regurgitation or cardiac tamponade that requiring surgery. The prompt and corrective management of procedure-induced accidental aortocoronary dissection during PCI needed to be evaluated.

METHODS: There were eight patients (6 males, 2 females; age 46, 49, 51, 52, 73, 79, 80 and 81, mean 63.8) had coronary atherosclerotic heart disease (4 RCA 85, 90, 90 and 100%, 1 LCx 95%; 1 LAD 100%; 2 LM+LAD 20 & 90, 40 & 70%, stenotic lesion, respectively). Risk factors were hypertension (6), diabetes mellitus (4), hyperlipidemia (6), elderly (4) and history of cigarette smoking (4). They all underwent percutaneous coronary intervention (PCI) that resulted in an acute aortocoronary dissection. Because of unstable hemodynamic conditions (7 requiring inotropics IV, 6 CPR, 3 IABP, 2 temporary pacing and 2 ECMO), three of them underwent emergency surgery with repair and graft replacement of aorta plus saphenous vein grafting (SVG) (1), direct pledget repair of the torn aortic intimal flap and entry (2) in addition to SVG (one needed a coronary endarterectorny), respectively.

RESULTS: Three received PCI with stenting for dissected LM. Two received ECMO support. Three of the dissection flap involved about 1cm distance from the RCA orifice (NHLBI Type III and Grade 2), three extended more than 4cm above the aortic root (NHLBI Type III, Grade 3), one involved sinus of Valsalva only (NHLBI Type III and Grade 1) and the rest one did not extend to the aorta. The guiding catheters implicated in dissection were Judkins (3), EBU (2), Kimney (2) and Amplatz (1). Three patients had calcified atherosclerotic plaques and the other 3 had atheromas. Six pts were discharged uneventfully after 3, 5, 7, 9, 14 and 17 post-op days, respectively. Two with ECMO support deceased on the 2nd and the 3rd post-op days.

CONCLUSIONS: Accidental guiding catheter-induced aortocoronary dissection that resulted in acute coronary occlusion, acute aortic dissection or acute cardiac tamponade is a life-threatening complication. Aware of the problem as well as its prompt recognition and management are essential.

CLINICAL IMPLICATIONS: Aware of the procedure-induced acute aortocoronary dissection as well as its prompt recognition and management are essential.

DISCLOSURE: The following authors have nothing to disclose: Tsung-Po Tsai, Jung-Ming Yu, Mao-Jen Lin, Kai-Wei Chang, An-Hua Sun, Kuei-Chuan Chan, Heng Su, Shih-Chen Tsai, Su-Chin Tsao

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