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      Large non-coronary sinus of Valsalva aneurysm: a case report of an unusual cause of angina pectoris

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          Abstract

          Background

          Sinus of Valsalva aneurysm (SVA) is a rare cardiac abnormality occurring in 0.09% of the general population, but few reports have examined its recurrence. Unruptured SVAs are usually asymptomatic.

          Case summary

          A 50-year-old woman presented with chest pain and a history of surgery for a ruptured right coronary SVA 32 years prior. Echocardiography showed the recurrence of an unruptured SVA of the non-coronary sinus with moderate aortic regurgitation, severe mitral regurgitation, and severe tricuspid regurgitation. Cardiac computed tomography (CT) revealed compression of the right coronary artery (RCA) between the SVA and sternum. Adenosine triphosphate stress myocardial perfusion imaging (MPI) identified reversible ischaemia of the inferior wall. The patient underwent patch closure of the SVA, aortic valve replacement, mitral valvuloplasty, and tricuspid annuloplasty. Post-operative MPI showed no residual ischaemia, and CT confirmed both successful repair of the SVA and intact RCA.

          Discussion

          This case provides two noteworthy findings. First, the SVA recurred after 32 years. Second, a non-coronary SVA causing myocardial ischaemia is extremely rare given the long anatomical distance between the non-coronary sinus and coronary arteries. In our patient, the non-coronary SVA grew large enough within the anterior mediastinum to cause RCA compression.

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          Most cited references 11

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          Sinus of valsalva aneurysms: review of the literature and an update on management.

          Sinus of Valsalva aneurysm (SOVA), a congenital or acquired cardiac defect that is present in roughly 0.09% of the general population, often presents as an incidental finding during cardiac imaging. Although an echocardiogram is the standard imaging technique for such findings, cardiac computed tomography angiography (CCTA) has been increasingly utilized. If SOVA is diagnosed, CCTA is also a useful test for patients who are at low to intermediate risk for coronary artery disease (CAD) prior to surgical repair. CCTA can accurately rule out CAD, obviating the need for invasive angiography in most cases, which may be more risky in SOVA patients because their coronaries may be more difficult to engage and their aortic root may be more prone to injury. Although surgery has previously been the treatment of choice, transcatheter techniques have added to the spectrum of nonsurgical alternatives for repair. We report here 4 incidental SOVA cases and review the current literature.
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            Unruptured aneurysm of the left sinus of valsalva causing coronary insufficiency: case report and review of the literature.

            Aneurysm of the left sinus of Valsalva is extremely rare. Compression of the left coronary artery by such an aneurysm is an unusual complication of this condition and can cause coronary insufficiency. We describe the case of a 75-year-old woman who had an isolated unruptured aneurysm of the left coronary sinus with intraluminal thrombus, which caused coronary artery compression. We performed successful surgical correction by closing the mouth of the aneurysm without aortic valve replacement or coronary artery bypass grafting. A review of the world medical literature revealed 19 cases of sinus of Valsalva aneurysms that hindered the coronary arterial flow. The previously published reports of this rare condition and its treatment are discussed herein.
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              [Sinus of Valsalva aneurysm as a cause of acute myocardial infarction].

              Aneurysmal dilatation of one or more of the sinuses of Valsalva (SVA) is a rare cause of coronary insufficiency. We describe one case of unruptured and partially thrombosed right sinus of Valsalva aneurysm of which the first sign was acute inferior myocardial infarction in a 40-year-old man while reviewing the literature, we found 44 reported cases of sinus of Valsalva aneurysm, complicated by myocardial ischemia or infarction. In 28 cases the left coronary sinus was involved, in 12 cases the right one, and in 4 cases both of them. Myocardial ischemia is a potentially ominous prognostic sign in SVA patients. The poor outcome with conservative treatment leads us to consider the patient for emergency surgical therapy.
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                Author and article information

                Contributors
                Role: Editor
                Role: Editor
                Role: Editor
                Role: Editor
                Role: Handling Editor
                Role: Editor
                Journal
                Eur Heart J Case Rep
                Eur Heart J Case Rep
                ehjcr
                European Heart Journal: Case Reports
                Oxford University Press
                2514-2119
                October 2020
                07 September 2020
                07 September 2020
                : 4
                : 5
                : 1-6
                Affiliations
                Department of Cardiovascular Medicine, Akita University Graduate School of Medicine , 1-1-1, Hondoh, Akita 010-8543, Japan
                Department of Cardiovascular Medicine, Akita University Graduate School of Medicine , 1-1-1, Hondoh, Akita 010-8543, Japan
                Department of Cardiovascular Surgery, Akita University Graduate School of Medicine , Akita, Japan
                Department of Cardiovascular Medicine, Akita University Graduate School of Medicine , 1-1-1, Hondoh, Akita 010-8543, Japan
                Author notes
                Corresponding author. Tel: +81-18-884-6110, Email: hirow@ 123456doc.med.akita-u.ac.jp
                Article
                ytaa241
                10.1093/ehjcr/ytaa241
                7649468
                © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                Page count
                Pages: 6
                Product
                Categories
                Case Reports
                Cardiac Imaging (Echocardiography / Cardiac MRI / Nuclear Cardiology)
                AcademicSubjects/MED00200

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