Concomitant Right Coronary Artery, Aortic and Pulmonary Artery Dissection after Coronary Catheterization and Fractional Flow Reserve Measurement

Background: Iatrogenic coronary artery dissection and an iatrogenic aortic dissection are two individual rare complications after coronary catheterization. An isolated pulmonary artery dissection is an even more rare complication. It is important to keep in mind that even routinely performed clinical procedures may involve severe complications, stressing the necessity of a thorough pre-, per- and post-procedure evaluation. Aim: To report a rare case of three combined dissections, caused by a routine coronary catheterization and fractional flow reserve (FFR) measurement; to provide an overview of the literature describing occurrence of each dissection; to describe possible treatment options and other reported cases. Case presentation: We present a case in which a coronary catheterization with FFR measurement caused three concomitant dissections. Coronary artery stenting and salvage surgical aortic repair (Bentall procedure) were technically successful, although a severe concomitant pulmonary artery dissection proved to be fatal. Conclusion: Combined acute coronary artery, aortic and pulmonary artery dissection is a life-threatening condition where, in severe cases, no obvious treatment options are available. Outcome and possible treatment options depend on the extent of each dissection.