A 73-year-old man underwent percutaneous angioplasty due to unstable angina CCS III-IV. He had a history of mild chest pain for the last 20 years with a crescendo pattern in the early past. No pathological findings were detectable in electrocardiography. His cardiovascular risk factors included history of nicotine abuse, hypertension, as well as hyperlipidemia. Due to the severity of the angina an elective catheterization via the right radial artery was planned. Mecain 1% injection solution was used as a local anesthetic and verapamil was administered as an intra-arterial vasodilatory agent. For anticoagulation 5.000 IE heparin and 150 mg clopidogrel were applied.\nThe process of advancing the guide wire toward the ascending aorta has been described as difficult due to a kinking of the brachiocephalic trunk. As in the first case, the procedure was performed by an experienced cardiologist with a large number of transradial catheterizations performed. During the procedure the wire was not forced and a polymer-jacketed guidewire was used.\nHis coronary angiography revealed the presence of a chronic collateralized stenosis in the proximal third of the right coronary artery, diffuse sclerosis, and calcifications with high degree stenoses of the ramus circumflexus and the proximal left anterior descending coronary artery. After an extensive interdisciplinary discussion of the diagnostic findings it was decided to perform interventional treatment. During the switch to a guide catheter (Braun; Serpia; XB 3,5; 6 French) advancing the guide wire into the ascending aorta again appeared to be difficult and ultimately frustrating. The subsequent angiography demonstrated a strong suspicion of a dissection of the brachiocephalic trunk. A subsequent CT angiography confirmed a dissection of both the brachiocephalic trunk as well as the aortic arch (). The patient was referred to the Department of Cardiac Surgery for further conservative treatment and coronary artery bypass grafting. No repair of the ascending aorta was required, as the false lumen of the dissection spontaneously thrombosed and the dissection was treated conservatively.
A36-year-old man was referred to our echocardiography department for follow-up echocardiography. He had undergone the Bentall operation 8 months previously because of an aneurysmal dilation of the ascending aorta (59 mm). His clinical history and physical examinations were unremarkable. Transthoracic echocardiography revealed a round, well-defined mass (35 mm × 32 mm) on the left side of the aortic tube graft in the modified parasternal short-axis view at the level of the aorta [ and ]. The other echocardiographic findings included preserved systolic left ventricular function (ejection fraction = 50%), mild right ventricular dysfunction, up-to-moderate mitral regurgitation, mild tricuspid regurgitation, and a normally functioning bileaflet mechanical aortic valve. Computed tomography (CT) angiography of the aorta showed a well-defined hematoma in the mid-mediastinal space below the pulmonary artery []. The left main coronary site implantation and the distal anastomosis site of the aortic tube graft were intact, and no connection was seen between the aortic tube graft and this hematoma. Because this hematoma produced no compressive symptoms and signs, the heart team decided to follow-up the patient.