El-Haress Mohamad, Daadaa Hicham, Shahjouei Shima, El-Bitar Firas, Bahmad Hisham
Faculty of Medicine, Beirut Arab University , Beirut , Lebanon.
Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences , Tehran , Iran.
Front Surg. 2017 Feb 3;4:2. doi: 10.3389/fsurg.2017.00002. eCollection 2017.
Iatrogenic acute ascending aortic dissection during percutaneous coronary intervention (PCI) is an exceptionally rare and life-threatening sequel that requires early and accurate diagnosis along with rapid management. No guidelines have yet been established to direct decisions on the different treatment options that can be employed in the setting of acute aortic dissections caused by PCI. However, similar cases have been treated either by intracoronary stenting and conservative management as in localized aortocoronary dissections or by surgical intervention in cases of extensive aortic dissections.
Hereby, we present a rare case of a female patient who developed "full-blown" acute ascending aortic dissection (Stanford type A-DeBakey type II dissection) with intramural hematoma during an elective percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA) and left circumflex artery (LCA). Accordingly, emergent surgical repair of the dissected aorta was performed including grafting of supracoronary ascending aortic tube, along with coronary artery bypass graft placement and septal myomectomy for severely hypertrophied cardiac septum. The patient recovered successfully without any documented postoperative complications.
It is pivotal to avoid aggressive use of instrumentation during PTCA in order to prevent the potential development of catheter-induced aortic dissection.
经皮冠状动脉介入治疗（PCI）期间发生的医源性急性升主动脉夹层是一种极为罕见且危及生命的并发症，需要早期准确诊断并迅速处理。目前尚未制定指导方针来指导针对PCI所致急性主动脉夹层可采用的不同治疗方案的决策。然而，类似病例的处理方式，在局限性主动脉冠状动脉夹层时采用冠状动脉内支架置入和保守治疗，在广泛性主动脉夹层时则采用手术干预。
在此，我们报告一例罕见病例，一名女性患者在择期经皮腔内冠状动脉成形术（PTCA）治疗右冠状动脉（RCA）和左旋支动脉（LCA）期间发生了伴有壁内血肿的“典型”急性升主动脉夹层（斯坦福A型 - 德巴基II型夹层）。因此，对夹层主动脉进行了紧急手术修复，包括冠状动脉上升主动脉管移植，以及冠状动脉旁路移植术和对严重肥厚的心脏间隔进行间隔心肌切除术。患者成功康复，术后无任何并发症记录。
在PTCA期间避免过度积极使用器械以防止导管引起的主动脉夹层的潜在发生至关重要。
