Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Case Report

Volume 8, Number 2, April 2017, pages 68-72

Late Presentation of Aortic Aneurysm and Dissection Following Cardiac Catheterization

Figures

Figure 1.
Figure 1. (a) Baseline two-dimensional (2D) parasternal long axis echocardiographic image obtained prior to index cardiac catheterization showing normal size aortic root and ascending aorta (Ao). (b) Corresponding 2D parasternal echocardiographic image 1 month following cardiac catheterization showing massive dilatation of the aortic root and ascending aorta (Ao) with a dissection flap. LV: left ventricle; RV: right ventricle; LA: left atrium.
Figure 2.
Figure 2. (a) Axial CT angiographic image showing the dissection starting at the aortic root and sparing the origins of the coronary arteries, with massive dilatation of the aortic root. (b) Sagittal CT angiographic image showing the extension of the dissection to the origin of the brachiocephalic artery.
Figure 3.
Figure 3. Dunning classification of ITAAD [2].

Tables

Table 1. Summary of ITAAD Case Reports With Favorable Outcomes
 
Case reportAgeSexPresentationInitial procedureDissection LocationDissection treatment
Sakakura et al [8]79MAnginaProximal RCA stentRight aorto-coronaryIVUS-directed intimal tear stent
Fiddler et al [9]65FAMIRCA stent (ITAAD caused by guidewire; tamponade)RCA ostium, aortic root and ascending aortaObservation
Kerut et al [10]79MAnginaAngiography (prior CABG and LM stent)Orifice of LM and up 4 cmObservation
Ghaffari and Pourafkari [11]30MCoarctation of aortaAortography (high pressure contrast; curved catheter)Proximal to right brachiocephalic arteryObservation
Gorog et al [12]56FSuspected coronary diseaseAngiography (difficulty advancing guidewire)Femoral artery to aortic archEntry point stent at external iliac
Shah et al [13]52MInferior AMIDifficult PCIRCA cusp and upward in the ascending aortaStent of the RCA and entry point
68MAnginaCircumflex stent (guidewire tip unroofing; forceful contrast injection)Left main cuspLeft main stent
Subsequent CABG
Welch et al [14]65Finferior AMIMultiple RCA stentsRCA cusp to brachiocephalic arteryDelayed surgery with aortic graft and CABG
Lambelin et al [15]75FAortic insufficiencyAngiography (non-selective injection of RCA)4 cm above AV; no coronary involvementImmediate surgery for tamponade
Noguchi et al [16]66MInferior AMICircumflex stent (developed tamponade)Brachiocephalic artery; no coronary involvementEmergent surgery for tamponade
Yilik et al [17]65FUnstable anginaAngioplasty of LADLAD to proximal aortaEmergency surgery
73FUnstable anginaAngioplasty of RCARCA to aortaEmergency Surgery
Tochii et al [18]69MLeft subclavian stenosisAngioplasty of left subclavianLeft subclavian and retrogradelySurgery

 

Table 2. Potential Patient Characteristics and Procedural Variables Associated With ITAAD
 
Patient characteristicsProcedural variables
AMIPCI (balloon, stent)
Unstable anginaHigh pressure contrast injection
PCI/CABG historyNonselective coronary injection
AortopathyGuidewire unroofing
AtherosclerosisCurved catheter
MaleDifficult guidewire maneuver
ElderlyRCA involvement