Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:204 - Vol. 71 Num.03 DOI: 10.1016/j.rec.2017.05.027

Ruptured Sinus of Valsalva Aneurysm Causing Myocardial Infarction

Wilman Olmedo a,, Michael Weinreich a, Pedro A. Villablanca a

a Division of Cardiovascular Disease, Montefiore Medical Center/Albert Einstein College of Medicine, New York, United States

Article

Acute coronary syndromes and cardiogenic shock as a presentation of unruptured left sinus of Valsalva aneurysms have been described; however, this is the first reported case of a ruptured sinus of Valsalva aneurysm causing compression of the coronary arteries.

A 56-year-old man with a history of hypertension and tobacco use presented to the emergency department with chest pain after sexual intercourse. An electrocardiogram showed nonspecific ST-T wave changes in the inferolateral leads. The troponin I level was 3.14 ng/mL. Immediate coronary angiography demonstrated displacement of the left main, left anterior descending, and left circumflex arteries. The findings were suspected to be due to external compression by a hematoma from a type A aortic dissection affecting the left sinus of Valsalva (SV) (Figure 1).

Figure 1.

Computed tomography imaging revealed a large, partially thrombosed aneurysm of the left SV with a small hemopericardium (Figure 2), suggesting contained rupture of the left SV, which was causing compression and displacement of the coronary arteries.

Figure 2.

The patient was emergently taken to the operating room. A large fresh thrombus within the aneurysmal cavity was found and removed. The mouth of the aneurysm was approximately 3.0 x 1.5 cm and leftward to the ostium of the left main artery (Figure 3). A vein graft bypass to the left circumflex, left internal mammary artery bypass to the left anterior descending, followed by a patch to the affected SV were performed. Forty days later, the patient was discharged home with a normal ejection fraction and neurological function.

Figure 3.

Corresponding author: wilmanmd@gmail.com

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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