JACC: CARDIOVASCULAR INTERVENTIONS
VOL. 3, NO. 7, 2010
© 2010 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
DOI: 10.1016/j.jcin.2010.04.014
IMAGES IN INTERVENTION
Yin and Yang in Interventional Cardiology
Gregory A. Sgueglia, MD, Francesco Burzotta, MD, PHD, Rocco Mongiardo, MD,
Italo Porto, MD, PHD
Rome, Italy
Figure 1. IVUS-Assisted Wiring
Intravascular ultrasound (IVUS) shows wiring of the false lumen at first (A), and then confirms successful rewiring of the true lumen (B).
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
From the Istituto di Cardiologia, Università Cattolica del Sacro Cuore,
Rome, Italy.
Manuscript received March 28, 2010, accepted April 17, 2010.
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. E-mail:
[email protected].
