© 2014, Wiley Periodicals, Inc. DOI: 10.1111/joic.12164
CLINICAL IMAGES Aortic Dissection Flap Imitating Intracoronary Thrombus: An Extremely Rare Angiographic Presentation of Acute Myocardial Infarction HAKAN ERKAN, M.D., 1 ÖMER FARUK ÇIRAKOĞLU, M.D., 1 MERVE ERKAN, M.D., 2 and GÜLHANIM KIRIŞ, M.D. 1 From the 1Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey; and 2Department of Radiology, Karadeniz Technical University Hospital Trabzon, Turkey
(J Interven Cardiol 2015;28:117–118)
Thirty‐two‐year‐old woman was admitted to the emergency department for 2 hours chest pain. She takes oral contraceptive pills to avoid pregnancy. Electrocardiography was consistent with an acute inferior myocardial infarction. Diagnostic coronary angiography revealed normal left coronary system and subtotal occlusion in the right coronary artery (RCA) (Video 1, Fig. 1). Initially, subtotal occlusion in RCA was considered non‐atherogenic arterial thrombosis caused by oral contraceptive pill. Thrombus aspiration and percutaneous coronary intervention were planned. Then, we noticed severe aortic regurgitation (Video 2). Therefore, we suspected acute aortic dissection. Aortography with hand injection by right judkins catheter demonstrated intense contrast filling to false lumen throughout ascending aorta (Video3, Fig. 2). Type I aortic dissection was confirmed by CT imaging (Fig. 3). Patients underwent emergency surgery that revealed bicuspid aortic valve disease as an etiological factor for aortic dissection. The patient was discharged at the 12th postoperative day without complications. Cannulation of right coronary ostium may be
Address for reprints: Hakan Erkan, MD Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Çamlık Street, 61040, Trabzon, Turkey. Fax: þ9 0 462 231 04 83; e‐mail: [email protected]
Vol. 28, No. 1, 2015
challenging in a patient with type I aortic dissection, since aortic dissection flap may interfere with catheter tip engagement to RCA. In this case, forceful catheter manipulation in ascending aorta has resulted in protruding intimal flap to RCA ostium that might have led to a thrombus‐like appearance in right coronary ostium.
Figure 1. Subtotal occlusion (arrow) of RCA with aortic dissection flap on LAO angiographic view.
Journal of Interventional Cardiology
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ERKAN, ET AL.
Figure 2. Aortography demonstrated intense contrast filling (arrow) to false lumen throughout ascending aorta.
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Figure 3. CT scan demonstrated type I aortic dissection (arrow).
Journal of Interventional Cardiology
Vol. 28, No. 1, 2015
CLINICAL IMAGES Aortic Dissection Flap Imitating Intracoronary Thrombus: An Extremely Rare Angiographic Presentation of Acute Myocardial Infarction HAKAN ERKAN, M.D., 1 ÖMER FARUK ÇIRAKOĞLU, M.D., 1 MERVE ERKAN, M.D., 2 and GÜLHANIM KIRIŞ, M.D. 1 From the 1Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey; and 2Department of Radiology, Karadeniz Technical University Hospital Trabzon, Turkey
(J Interven Cardiol 2015;28:117–118)
Thirty‐two‐year‐old woman was admitted to the emergency department for 2 hours chest pain. She takes oral contraceptive pills to avoid pregnancy. Electrocardiography was consistent with an acute inferior myocardial infarction. Diagnostic coronary angiography revealed normal left coronary system and subtotal occlusion in the right coronary artery (RCA) (Video 1, Fig. 1). Initially, subtotal occlusion in RCA was considered non‐atherogenic arterial thrombosis caused by oral contraceptive pill. Thrombus aspiration and percutaneous coronary intervention were planned. Then, we noticed severe aortic regurgitation (Video 2). Therefore, we suspected acute aortic dissection. Aortography with hand injection by right judkins catheter demonstrated intense contrast filling to false lumen throughout ascending aorta (Video3, Fig. 2). Type I aortic dissection was confirmed by CT imaging (Fig. 3). Patients underwent emergency surgery that revealed bicuspid aortic valve disease as an etiological factor for aortic dissection. The patient was discharged at the 12th postoperative day without complications. Cannulation of right coronary ostium may be
Address for reprints: Hakan Erkan, MD Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Çamlık Street, 61040, Trabzon, Turkey. Fax: þ9 0 462 231 04 83; e‐mail: [email protected]
Vol. 28, No. 1, 2015
challenging in a patient with type I aortic dissection, since aortic dissection flap may interfere with catheter tip engagement to RCA. In this case, forceful catheter manipulation in ascending aorta has resulted in protruding intimal flap to RCA ostium that might have led to a thrombus‐like appearance in right coronary ostium.
Figure 1. Subtotal occlusion (arrow) of RCA with aortic dissection flap on LAO angiographic view.
Journal of Interventional Cardiology
117
ERKAN, ET AL.
Figure 2. Aortography demonstrated intense contrast filling (arrow) to false lumen throughout ascending aorta.
118
Figure 3. CT scan demonstrated type I aortic dissection (arrow).
Journal of Interventional Cardiology
Vol. 28, No. 1, 2015
