INTRODUCTION
Iatrogenic aortocoronary dissection(IACD) is a fatal complication
occurring in 0.02 - 0.04% cases1-2,6 of coronary
catheterization that requires early recognition and emergent surgical
treatment. Aortic dissection may lead to serious complications like
myocardial infarction or sudden cardiac death. Most described cases
occurred during catheterization and angioplasty of the Right Coronary
Artery(RCA) 3-4. The morphological and structural
differences between right and left coronary arteries may explain the
fact that left aortic sinus is less prone to iatrogenic
dissection5. Various options have been tried by many
in the past including Coronary Artery Bypass Grafting(CABG) with aortic
dissection repair, stenting the coronary artery, monitoring the aortic
dissection using Transesophageal echocardiography(TEE), implanting
coronary stents to maintain coronary blood flow before surgery and
repairing aortic dissection surgically. Our patient had RCA Dissection
which was extending to the ascending aorta with intramural hematoma.
Reverse saphenous vein graft(RSVG) was used to revascularize the RCA
with supracoronary replacement of the ascending aorta. Because of the
significant disease in the proximal Left Anterior Descending
Artery(LAD), a separate RSVG-LAD graft was also done.