Structural Features of the Sinus of Valsalva and the Proximal Portion of the Coronary Arteries: Their Relevance to Retrograde Aortocoronary Dissection

• Published in: Revista española de cardiologia 2006-07, Vol.59 (7), p.696-702
• Main Authors: López-Mínguez, José R., Climent, Vicente, Yen-Ho, Siew, González-Fernández, Reyes, Nogales-Asensio, Juan M., Sánchez-Quintana, Damián
• Format: Article
• Language: eng ; spa
• Subjects: ACTP; Adult; Aged; Aneurysm, Dissecting - etiology; Angioplasty, Balloon, Coronary - adverse effects; Aortic Aneurysm - etiology; Aortic sinuses; Aortocoronary dissection; Cadaver; Coronary Aneurysm - etiology; Coronary Vessels - pathology; Disección aortocoronaria; Enfermedad isquémica; Female; Humans; Intraoperative Complications - etiology; Ischemic heart disease; Male; Middle Aged; PTCA; Senos aórticos; Sinus of Valsalva - pathology
• ISSN: 1885-5857; 0300-8932; 1885-5857
• DOI: 10.1016/S1885-5857(07)60028-0

Retrograde aortocoronary dissection is an unusual complication of coronary angioplasty. Our study provides new structural details of the aortic sinuses and the proximal portions of the coronary arteries, which enable better understanding of several clinical features associated with this complication. We studied eight aortic sinus specimens from patients with structural ischemic heart disease using dissection, histologic analysis, and scanning electron microscopy, and compared findings with those in eight control specimens. We observed the following features: a) in 10 specimens (71%), the left coronary artery diameter was greater than the right; b) the angle that the ascending aorta made with the left coronary artery was acute, whereas that with the right coronary artery was closer to a right angle, thereby possibly providing a better approach for catheterization; c) in contrast to those of the right coronary artery, the periostial wall and sinotubular junction of the left coronary artery were formed by more smooth muscle cells and by a dense matrix of collagen type-I fibers; and d) the aortic sinuses and coronary arteries in structural ischemic heart disease specimens displayed structural alterations that affected the aortic tunica media and the collagen distribution at the sinotubular junction. The morphological and structural differences observed between right and left sides suggest that the left aortic sinus is more resistant to traction and is, therefore, less prone to iatrogenic dissection. Structural ischemic heart disease is a risk factor that increases the likelihood of aortocoronary dissection. La disección retrógrada aortocoronaria es una complicación poco frecuente que si-gue a la angioplastia coronaria. Nuestro estudio propor-ciona nuevos detalles estructurales de los senos aórticos y la porción proximal de las arterias coronarias para un mejor entendimiento de aspectos relacionados con esta complicación. Hemos analizado mediante técnicas de disección, histológicas y de microscopia electrónica de ba-rrido los senos aórticos de 8 especímenes con cardiopatía isquémica estructural y se comparan con 8 especímenes control. Hemos observado las siguientes características: a) el diámetro de la arteria coronaria izquierda en 10 especímenes (71%) fue mayor que el de la derecha; b) el ángulo que forma la coronaria izquierda con la aorta ascendente es agudo, mientras que el de la coronaria derecha tiende a ser recto, por lo que puede presentar un mejor abo