Coronary artery dissection following aortic valve replacement. How can one deal with this rare yet life-threatening complication?

Coronary artery dissection following its cannulation for cardioplegia administration as a result of aortic valve replacement (AVR) is a rare but nevertheless life-threatening complication. The three cases of a patient suffering from aortic stenosis illustrated below focus on the issue of how to identify and treat the dissected artery. In all of the patients who had undergone AVR diagnosed was a periprocedural myocardial infarction. Angiography revealed the dissection of the left main in two of the patients, while in the third one that of the right coronary artery. In the case of local dissection, angiography was sufficient to identify the true lumen, whereas in a dissection encompassing the whole of the coronary tree it was necessary to either find the coronary artery not involved in the dissection or to perform intravascular ultrasound imaging. After true lumen identification, the entry of dissection was stented with the optimal angiographic result.