An Unexpected Cause Of Acute Coronary Syndrome: Iatrogenic Right Coronary Dissection as a Delayed Complication After Valve Replacement Surgery

Coronary artery dissection is a quite unusual but eventually lifethreatening complication, and most cases occur as an immediate adverse event after cardiac catheterization [1, 2]. Mostly, it affects the right coronary artery, due to its anatomical disposition [3]. Rarely it can affect the LMCA (1% of all procedures), as happened in the case reported, and it can have fatal consequences if the adequate management fails to be administered. Usual treatment comprises not only percutaneous intervention, but also surgical myocardial revascularization as long as patient’s haemodynamic stability can be achieved. But not only interventional procedures can be the cause of this complication. It has also been reported to occur in the scenario of a cardiac surgery procedure, despite being a much less frequent complication [4]. In the absence of any other explanation, the cause was assumed to be endothelial lesion due to the direct antegrade cannulation of the coronary ostia, for cardioplegic perfusion. Its clinical presentation is usually intraoperative or immediate post-operative ischemia, when a rapid management and usually surgical treatment is required, but it can also show up even more than a week after surgery, becoming a very unusual complication that should be considered in these patients, when they have a post-operative acute coronary syndrome.