DISSECTION OF THE AORTIC SINUS OF VALSALVA COMPLICATING CORONARY CATHETERIZATION - CAUSE, MECHANISM, EVOLUTION, AND MANAGEMENT

We have rarely observed the appearance of a dissection of the aortic s inus of Valsalva during catheterizations of the related coronary arter y, The aim of this study is to describe the cause, mechanism, and evol ution of this complication, which have Implications for the management of the patient, According to our experience (one case out of 12,546 d iagnostic and three cases out of 4,970 angioplasty procedures performe d during the last 6 years), the dissection of the sinus of Valsalva al ways results from the retrograde extension of a dissection of the righ t coronary artery, It usually remains localized, but it may quickly in volve the entire aorta. Contrast injections and balloon inflations pro mote its propagation, so these procedures should be avoided if possibl e. Instead of angiography, transesophageal echocardiogram is a safe an d accurate method for studying its extension and as a follow-up method . The sinus of Valsalva dissections that remain localized during cathe terization tend to spontaneously resolve in the first month. (C) 1998 Wiley-Liss, Inc.