Yin and Yang in Interventional Cardiology
Gregory A. Sgueglia, MD,
Francesco Burzotta, MD, PhD,
Rocco Mongiardo, MD,
Italo Porto, MD, PhD*
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
A 46-year-old hypertensive woman with a long history of atypical chest pain was admitted to our institution because of a very intense episode associated to transient ST-segment elevation on standard electrocardiogram. Coronary angiography revealed normal coronary arteries, and ergonovine provocation test was performed. During the test, a severe spiral dissection of the right coronary artery occurred. Iatrogenic coronary dissection is a rare and potentially life-threatening complication of diagnostic coronary catheterization. In such cases, stenting the true lumen is crucial to scaffold the vessel and restore its patency. However, identification of the true lumen by angiography only may be misleading. Intravascular ultrasound imaging is extremely helpful to assess wire position and ensure true lumen identification. Figure 1
shows the intravascular ultrasound probe within the false lumen, which had been wired at first (A), and subsequently within the true lumen (B). The images are reminiscent of the Taijitu symbol. Like in Yin and Yang, interconnected opposing duality is present in these intravascular ultrasound images, with both lumen giving rise to each other, although one is the path to life and the other a trail to death.
* Reprint requests and correspondence: Dr. Italo Porto, Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Largo F. Vito, Rome 00168, Italy (Email: italo.porto{at}gmail.com).
Manuscript received March 28, 2010;
accepted April 17, 2010.
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