An unusual complication of coronary angiography: bidirectional dissection of the right coronary artery and the ascending aorta.

Iatrogenic aortocoronary dissection is a rare but devastating complication of percutaneous coronary interventions. The authors present the case of a 45 years old woman admitted for anginal chest pain. She underwent coronary angiography and developed complete anterograde dissection of the right coronary artery simultaneously with retrograde extensive propagation to the ascending aorta. Failure to attempt stenting because of altered hemodynamics and intractable chest pain prompted an emergent bypass surgery with treatment of the aortic dissection. Causes and modalities of treatment of iatrogenic aortocoronary dissections are discussed.

Mycotic aneurysm of the tibioperoneal trunk. An extremely rare localization with pseudo-phlebitis clinical presentation.

Since antibiotics have been widely used in the treatment of bacterial endocarditis, mycotic aneurysms caused by septic emboli have become extremely rare. We report the case of a 66-year-old male patient who presented mycotic aneurysm of the right tibioperoneal trunk two weeks after aortic and mitral valve replacement due to Enterococcus fecalis endocarditis. The clinical presentation simulated thrombophlebitis of the deep veins of right calf. A pulsating mass was diagnosed clinically and duplex ultrasound confirmed the diagnosis of a mycotic aneurysm of the tibioperoneal trunk. Surgical treatment included the closure of the orifice of the aneurysm and excision of the aneurysmal sac. Arterial reconstruction was not required. Postoperative course was uneventful. No complication was observed at long-term follow-up. This observation represents the seventh case reported in the literature of mycotic aneurysm at this localization.

Acute limb ischemia secondary to heparin-induced thrombocytopenia after cardiac surgery.

UNLABELLED: Heparin-induced thrombocytopenia is an important and sometimes life-threatening immunological drug reaction. About 2.5% of patients receiving heparin develop immune-mediated (type II) heparin-induced thrombocytopenia that may be complicated by a paradoxical thrombotic syndrome either arterial or venous. This severe syndrome carries relevant rates of mortality and morbidity secondary to cerebral, myocardial and limb infarction. OBJECTIVE: To report two cases of successfully treated severe limb acute ischemia secondary to heparin-induced thrombocytopenia after cardiac surgery. METHODS: Seven days after aorto-coronary bypass and heparin exposure, a 75-year-old female patient developed acute ischemia of the left hand and a 60-year-old female patient presented a severe ischemia of the left lower extremity. Platelet count level decreased to 12000/mm3 in the first case and to 11000/mm3 in the second case. RESULTS: The first patient underwent emergent fasciotomy of the left hand and forearm and the second one had urgent thrombectomy of the left deep femoral, popliteal and posterior tibial arteries with venous patch angioplasty. Heparin was discontinued and warfarin started few days later. The patients had an uneventful course and they completely recovered. CONCLUSION: Early recognition of heparin-induced thrombocytopenia syndrome has allowed for significant advances in therapy leading to marked reduction in mortality and morbidity. Recently, available thrombin inhibitor drugs have dramatically changed outcomes for patients having this severe syndrome.