Late presentation of iatrogenic dissection of right coronary cusp: A case report
Ali Eshraghi1, Majid Jalalyazdi1, Javad Ramezani1
1Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Iatrogenic coronary artery dissection, though uncommon, can occur during catheter procedures. This case highlights a rare right coronary cusp dissection causing heart rhythm issues, managed successfully with stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Iatrogenic coronary artery dissection is a known complication during cardiac catheterization.
- Right coronary cusp dissection is a rare but serious iatrogenic injury.
Observation:
- A 54-year-old woman developed exertional dyspnea and chest discomfort post-diagnostic angiography.
- Delayed sub-intimal hematoma formation led to compression of the right coronary artery ostium and SA node branch.
Findings:
- The compression resulted in sinoatrial (SA) node dysfunction, causing junctional rhythm and atrial fibrillation.
- Successful management was achieved through stenting of the coronary ostium entry point.
Implications:
- This case underscores the importance of recognizing and managing rare iatrogenic coronary ostial dissections.
- Stenting the entry point offers a logical and effective solution for catastrophic dissections involving aortic cusps.
Abstract:
Iatrogenic dissection of coronary arteries while performing catheter engagement, in general is not uncommon. However, we encountered a relatively rare case of iatrogenic right coronary cusp dissection.Here we report an iatrogenic coronary artery dissection after diagnostic angiography in a 54-year-oldwoman presented with exertional dyspnea and chest discomfort. In our case delayed progression of sub-intimal hematoma and subsequent compression of RCA ostium an SA node branch was the cause of SA node dysfunction and subsequent junctional rhythm and atrial fibrillation. To conclude it should be said that in catastrophic cases of iatrogenic coronary ostia dissection and ensuing aortic cusp involvement, stenting of entry point at coronary ostia is a logical decision with good result.
