Skip to main content
main-content
Top

Tip

Swipe om te navigeren naar een ander artikel

Gepubliceerd in: Netherlands Heart Journal 2/2020

Open Access 14-08-2019 | Heart Beat

A patient with chest pain and a pulsating left main coronary artery

Auteurs: A. Y. Andreou, A. Karyou, A. Argyrou

Gepubliceerd in: Netherlands Heart Journal | Uitgave 2/2020

share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail
insite
ZOEKEN
Extras
Video 1 Non-selective left coronary artery angiography showing dynamic left main coronary artery lumen compromise during diastole
Video 2 Echocardiographic image. Parasternal long-axis view showing a dilated aortic root harbouring a dissection flap
Opmerkingen

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12471-019-01324-w) contains supplementary material, which is available to authorized users.
A 42-year-old female patient, a cigarette smoker with no known medical history, was referred for emergency coronary angiography because of acute coronary syndrome (ACS). She presented with sudden-onset chest pain associated with electrocardiographic evidence of ischaemia (Fig. 1a). Her blood pressure was 90/25 mm Hg. The right radial artery pulse was non-palpable. Thus we performed transfemoral coronary angiography, which showed no evidence of atherosclerosis but a smooth-bordered ostial and mid-shaft left main coronary artery (LMCA) stenosis with dynamic compression and almost complete lumen obliteration during diastole (Fig. 1b, c; Electronic Supplementary Material, Video 1). We suspected proximal aortic dissection (AD), which was confirmed by emergency echocardiography (Electronic Supplementary Material, Video 2). Indeed, LMCA pulsation was due to retrograde extension of the aortic false lumen into the LMCA causing diastolic compression of the true coronary lumen. The patient underwent a successful AD repair with Bentall’s procedure and hemi-arch replacement and patch repair of the dissected LMCA.
Acute proximal AD is complicated by retrograde dissection into either or both coronary ostia in 5.7–15% of cases [1, 2]; misdiagnosis with ACS may have a fatal outcome [3]. Dynamic LMCA lumen compromise during diastole is highlighted herein as a subtle and rare angiographic finding that should alert the interventional cardiologist to possible proximal AD extending into the LMCA.

Conflict of interest

A.Y. Andreou, A. Karyou and A. Argyrou declare that they have no competing interests.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Onze productaanbevelingen

Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

Bijlagen

Caption Electronic Supplementary Material

Video 1 Non-selective left coronary artery angiography showing dynamic left main coronary artery lumen compromise during diastole
Video 2 Echocardiographic image. Parasternal long-axis view showing a dilated aortic root harbouring a dissection flap
Literatuur
1.
go back to reference Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome. J Thorac Cardiovasc Surg. 2001;121:552–60. CrossRef Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome. J Thorac Cardiovasc Surg. 2001;121:552–60. CrossRef
2.
go back to reference Imoto K, Uchida K, Karube N, et al. Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection. Eur J Cardiothorac Surg. 2013;44:419–24. CrossRef Imoto K, Uchida K, Karube N, et al. Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection. Eur J Cardiothorac Surg. 2013;44:419–24. CrossRef
3.
go back to reference Kawano H, Tomichi Y, Fukae S, Koide Y, Toda G, Yano K. Aortic dissection associated with acute myocardial infarction and stroke found at autopsy. Intern Med. 2006;45:957–62. CrossRef Kawano H, Tomichi Y, Fukae S, Koide Y, Toda G, Yano K. Aortic dissection associated with acute myocardial infarction and stroke found at autopsy. Intern Med. 2006;45:957–62. CrossRef
Metagegevens
Titel
A patient with chest pain and a pulsating left main coronary artery
Auteurs
A. Y. Andreou
A. Karyou
A. Argyrou
Publicatiedatum
14-08-2019
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 2/2020
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-019-01324-w