Cardiac catheterization-induced type-A aortic dissection detected by intra-operative transesophageal...

Area of Science:

• Cardiology
• Vascular Surgery
• Medical Imaging

Background:

• Cardiac catheterization is a common procedure for diagnosing and treating coronary artery disease.
• Coronary artery dissection is a known, albeit infrequent, complication of cardiac catheterization.
• Emergency coronary artery bypass graft (CABG) surgery is the standard treatment for significant dissections causing unstable perfusion or stenosis.

Observation:

• This case highlights a rare complication where catheterization-induced right coronary artery (RCA) dissection extended to a progressive type-A aortic dissection.
• Transesophageal echocardiography (TEE) was instrumental in diagnosing the extent of the aortic dissection during emergent CABG surgery.
• The presence of retrograde coronary artery dissection, noted preoperatively, was a key indicator for potential aortic involvement.

Findings:

• Catheterization-induced RCA dissection can progress to aortic dissection.
• TEE provides critical real-time visualization of complex dissections during surgery.
• Early detection of aortic involvement via TEE allowed for modification of the surgical plan, including cardiopulmonary bypass cannulation site.

Implications:

• TEE is a valuable tool for identifying and managing rare, severe complications of cardiac catheterization.
• Awareness of potential aortic extension is crucial for surgeons performing emergent CABG for iatrogenic coronary artery dissection.
• This case underscores the importance of comprehensive imaging in managing iatrogenic vascular injuries.