Localized Aortic Root Dissection Secondary to Contrast Agent Injection: Feasibility of Conservative Followup With Echocardiography

Introduction: Iatrogenic aortocoronary dissection (ACD) is a nightmare in interventional cardiology. Although ACD is rarely reported, the realworld prevalence is suspected of being higher due to unreported cases. The right coronary artery (RCA) ostium is involved in the majority of cases, and dissections are usually limited to the aortic sinus in half of the clinical presentations. There are different treatment strategies, including interventional approaches, surgery, and medical followup. Immediate stent deployment to the coronary osteum might be a lifesaving procedure, and the surgical approach should be preferred in occasions of dissection extension beyond the sinotubular junctions. Catheter trauma and subintimal progression of guidewires are major causes of ACD occurrence.Case Presentation: Herein presented is a case report of spontaneous ACD observed after contrast injection to the RCA ostium. Approximately 8 cc of radiocontrast agent was injected into the right coronary ostium. Antegrade and retrograde dissections which extended to the distal RCA and aortic root were observed. The right sinus of Valsalva was stained with contrast agent, and the border of the stained area was extended to the sinotubular junction. Medical followup was proposed by the heart team. Close followup with echocardiographic examination indicated the complete regression of the dissection.Conclusion: The authors consider conservative followup with echocardiogaphy rather than computed tomography and/or magnetic resonance to be the most appropriate imaging technique for use with stable patients.