Giant left sinus of Valsalva aneurysm as a rare cause of acute myocardial infarction: a case report

Abstract

Background Sinuses of Valsalva Aneurysm (SVA) is a rare but potentially life-threatening condition. Acute myocardial infarction (MI) is a rare consequence of aneurysmal dilatation of one or more sinuses of Valsalva. We present a case of an unruptured and partially thrombosed left SVA, presenting as anterior MI and congestive heart failure. Case Summery A 55-year-old gentleman was admitted with pulmonary oedema and a late presenting ST elevation MI with Q wave. After initial treatment on furosemide infusion, a coronary angiography showed significant stenosis in both his left main stem (LMS) and left anterior descending artery (LAD). This is likely a result of external compression, potentially from the enlarged left sinus of Valsalva. A subsequent transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TOE) confirmed large SVA involving the left coronary cusp measured 9.9 cm compressing both LMS and LAD. Discussion Left SVAs are rare and frequently asymptomatic, typically being identified incidentally. Due to close proximity of the left coronary system, they can present with myocardial ischemia due to extrinsic compression of coronary system. We were able to perform a comprehensive multimodality assessment of left SVA which helped establish this unusual diagnosis and guide management. TTE & TOE helped assess the SVA and demonstrated the thrombus in situ, aortic valve insufficiency and the cardiac function. The computed tomography scan (CT) aided in accurately defining the extent of the aneurysm and the extent of compression of left coronary system and cardiac magnetic resonance scan (CMR) was able to demonstrate viability in LAD and CX territory.

Sinus of Valsalva Aneurysm: Different Modes of Presentation and Techniques of Repair

“…As a consequence, SVA ruptured into the right ventricle in 42 patients and into the right atrium in 18 patients. Patients with unruptured SVA are usually asymptomatic or present unspecific symptoms (rhythm disturbances, dyspnea or chest pains), while some patients may present with more life-threatening complications such as myocardial infarction, stroke and aortic regurgitation [3][4][5][6][7]. In the present series, the presentation was rather different: one suffered from heart failure due to intracardiac perforation, the second presented with severe aortic regurgitation due to progressive enlargement of the aortic root with displacement of the aortic commissures, the third patient suffered from a stroke most probably due to thrombotic embolization out of the SVA, while the last one presented with arrhythmias and the last one had moderate LVOT compression.…”