Dysplastic aortic cusp presenting with myocardial ischemia: diagnostic value of transesophageal echocardiography

Abstract

Dysplastic aortic cusp causing myocardial ischemia is a rare entity. We report a case and review 16 previously reported cases, and we discuss the limitation of different cardiac imaging modality in defining this abnormality.

Myocardial ischaemia and valve insufficiency caused by a dysplastic aortic valve cusp: a previously unreported unique morphologic anomaly

“…Transthoracic imaging alone has been debated to be inadequate for defining aortic valve morphological abnormalities in adults. 5 Cardiac MRI is an emerging imaging modality with excellent spatial resolution, functional resolution, and myocardial tissue characterisation. There is growing evidence of use of MRI in determining valvar morphology as it has the advantage to visualise the morphology and motion of the valve from any desired image orientation without limitation of optimal windows, especially when the echocardiographic assessment is inconclusive.…”

“…These reports include varying degrees of abnormal aortic valve morphology such as a hypoplastic left coronary cusp and abnormal cusp attachments the aortic wall causing myocardial ischaemia. 5,6 Case presentation A 21-year-old female was referred at 30 weeks gestation for fetal echocardiography for suspicion of cardiomegaly on routine obstetric ultrasound screening. The fetal echocardiogram confirmed cardiomegaly with left ventricle dilation and evidence suggestive of endocardial fibroelastosis.…”

Misdiagnosis in Hypoplastic Sinus of Valsalva with Localized Aneurysm: A Diagnostic Pitfall in Computed Tomography

“…The most common congenital structural abnormality in the sinus of Valsalva is a diffusely dilated aneurysm, which is caused by a localized weakness at the junction of the aortic media and the annulus fibrosus cordis. Patients with a hypoplastic sinus of Valsalva are rarely reported; they are often young and present with angina or sudden death because of insufficient coronary blood flow . Our middle‐aged patient presented with minor symptoms because her smaller left aortic sinus provided sufficient diastolic coronary blood flow.…”

“…Patients with a hypoplastic sinus of Valsalva are rarely reported; they are often young and present with angina or sudden death because of insufficient coronary blood flow. [1][2][3][4] Our middle-aged patient presented with minor symptoms because her smaller left aortic sinus provided sufficient diastolic coronary blood flow. Moreover, although the outpouching morphology of the left aortic sinus indicated a localized sinus of Valsalva aneurysm, surgical correction was not necessary for the small size and functionally normal sinus of Valsalva.…”

Occlusion of the os of the left coronary artery by dysplastic aortic valve tissue presenting as progressive mitral insufficiency and cardiac arrest

“…On echocardiogram, they commonly had aortic regurgitation or supravalvular aortic stenosis. [7][8][9] The aortic valve is typically well-visualised by transthoracic echocardiography, allowing for delineation of the morphology of the commissures and fusion of leaflets. In addition, transthoracic echocardiography with colour Doppler is an important tool for evaluation of the coronary arteries and can reliably image the proximal coronary arteries.…”