Isolated acute iatrogenic aortic dissection during percutaneous coronary intervention without involvement of the...

Area of Science:

• Cardiology
• Vascular Surgery
• Pathology

Background:

• Coronary angiography is a standard procedure for diagnosing coronary artery disease.
• Complications, though rare, can arise from invasive cardiovascular interventions.
• Acute aortic dissection is a life-threatening condition involving a tear in the aorta's inner layer.

Observation:

• A 63-year-old male developed acute aortic dissection with supracoronary entry during attempted left coronary artery intubation.
• The dissection occurred without direct involvement of the coronary arteries.
• Emergency surgery was performed, including aortic valve prosthesis implantation and replacement of the supracoronary thoracic aorta and aortic arch.

Findings:

• Histological examination revealed myxoid degeneration and disrupted elastic fiber architecture in the aorta.
• The patient exhibited no clinical features of hereditary connective tissue diseases.
• Skin biopsy excluded signs of Marfan's or Ehlers Danlos Syndrome.

Implications:

• This case highlights a rare complication of coronary angiography, emphasizing the importance of careful catheter technique.
• Myxoid degeneration without syndromic features suggests potential idiopathic aortic disease.
• Further investigation into the etiology of aortic degeneration in the absence of connective tissue disorders is warranted.