Ascending Aortic Pseudoaneurysm With Compression of Left Main Coronary Artery

Extrinsic Circumflex Coronary Artery Compression and Occlusion by Mycotic Aneurysm of Left Aortic Sinus

“…2 Compression of the LMCA between the aorta and pulmonary artery has been demonstrated by multimodality imaging in anomalous origin of left coronary artery from right sinus and interarterial course. 3 The LMCA can also be compressed by aneurysmal structures in the vicinity of the aorta such as congenital and pseudoaneurysms of the aortic sinus of Valsalva, 4,5 submitral left ventricular aneurysm, 6 and MAIVF aneurysm in aortic valve [7][8][9] The most commonly reported lesion is the MAIVF aneurysm (Figure 1E). Sudhakar et al, 9 in their review of 88 cases of MAIVF aneurysm, reported compression of one or more coronary arteries in 10 cases (11%): circumflex in all, LM in seven, and left anterior descending artery in three.…”

“… 4 Acquired aneurysms are much less common than congenital and may be spontaneous due to cystic medial necrosis, postsurgical status, trauma, Takayasu's arteritis, or endocarditis. 5 , 10 , 11 , 12 , 13 Unruptured SVA may be discovered as an incidental finding 10 or cause symptoms related to right ventricular outflow obstruction, left ventricular outflow obstruction, complete heart block, or ventricular tachycardia. Ruptured aneurysms may present with heart failure due to left-to-right shunt.…”

“… 1 Myocardial ischemia and infarction due to extrinsic compression of a left coronary artery are unusual and have been the subject of rare case reports. They have been described as being due to severe pulmonary artery dilation in patients with pulmonary hypertension, 2 anomalous origin of left coronary artery from right aortic sinus with interarterial course, 3 congenital aortic sinus of Valsalva aneurysms (SVAs), 4 pseudoaneurysm following ascending aortic replacement surgery, 5 and submitral left ventricular aneurysms. 6 Aortic valve endocarditis can be complicated by a variety of subaortic ( Figure 1 ) 7 , 8 , 9 and periaortic ( Figure 2 ) 10 , 11 , 12 , 13 structural complications.…”