Sinus of Valsalva Aneurysm from Left Coronary Sinus with Aortic Root Dilatation: A Rare Case

Occlusion of Left Coronary Ostium With a Rudimentary Aortic Cusp

Rupture of Sinus of Valsalva Causing Fistula Between Left Coronary Sinus and Left Atrium.

An aberrant origin of the left main coronary artery (LM) or left anterior descending coronary artery (LAD) from the right sinus of Valsalva is a rare anomaly that has been associated with myocardial ischemia and sudden cardiac death. Depending on the anatomic relationship of the anomalous vessel to the aorta and the pulmonary trunk, the anomaly can be classified into 4 common courses: posterior, interarterial, anterior, and septal course. Contrast-enhanced electron beam tomography (EBT) has been shown to permit classification of anomalous coronary arteries. We present 4 cases that illustrate the common variations of this anomaly. In all cases, EBT was performed using a C-150 XP EBT scanner (Imatron Inc). During inspiratory breathhold, 40 to 50 axial cross-sections of the heart were acquired triggered to the ECG at 40% of the R-R interval (100 ms acquisition time, slice thickness 3 mm, table feed 2 mm, intravenous injection of 160 mL contrast agent …

Surgical Treatment of Anomalous Aortic Origin of Coronary Arteries: The Reimplantation Technique and Its Modifications

A 45-year-old male with no significant medical history or risk factors for coronary disease presented with a 1-year history of intermittent, exertional chest pain radiating to the neck. Physical examination was unremarkable. An EKG was normal. A chest X-ray, however, revealed a 4-cm round focus with peripheral calcification overlying the left side of the heart. A computed tomography (CT) of the chest revealed a spherical area with rim calcification in the area of the aortic root on the left. The differential diagnosis at that point was: a calcified left coronary artery aneurysm, left ventricular anterior wall calcified pseudoaneurysm or a pseudoaneurysm arising from the left aortic root. This prompted a CT angiogram of the coronary arteries. His coronary arteries all appeared normal on imaging, but the calcified mass was localized to have originated from the left coronary sinus of Valsalva. It appeared to be a ruptured aneurysm of the left coronary sinus, which led to the formation of a pseudoaneurysm with peripheral calcification. It was felt that the process was chronic due to the long history of angina and calcification present within the sac. The superior margin of the neck of the pseudoaneurysm was 2 mm inferior to the origin of the left coronary artery, and the inferior margin was contiguous with the hinge point of the left leaflet (Fig. 1A). Figure 1: (A) Coronal, axial and sagittal views of a CT angiogram showing a chronically ruptured left sinus of Valsalva contained within a calcified pseudoaneurysm. (B) 3D reconstruction of the heart and coronary arteries demonstrating the relationship between ... His symptoms were thought to be related to external compression of the proximal left main coronary artery (LMCA; Fig. 1B). To better assess the aortic root and coronary arteries, the patient underwent cardiac catheterization, which confirmed the finding of normal coronary arteries, but revealed displacement of the LMCA due to mass effect from the pseudoaneurysm (Fig. 1C—left). Selective angiography of the aortic root and left coronary sinus revealed a thick layer of organized thrombus within the sac without fistulization (Fig. 1C—right). It was recommended he undergoes surgical resection and repair to prevent further complications, including hemodynamically significant rupture, fistula formation or heart failure, but the patient refused to undergo operative management. True aneurysms of the sinus of Valsalva (ASVs) are either congenital or acquired. Congenital ASVs are rare anomalies most often caused by the absence of muscular and elastic tissue in the aortic wall behind the sinus of Valsalva. Acquired ASVs are caused by conditions that affect the integrity of the aortic wall such as infections (e.g. bacterial endocarditis, syphilitic aortitis or tuberculosis), degenerative disease (e.g. atherosclerosis and connective tissue disease) or trauma. Most ASVs originate from the right coronary sinus (94%), and a minority originates from the non-coronary sinus (5%). Very rarely is the left coronary sinus affected [1, 2]. Pseudoaneurysms—or false aneurysms—are formed when a break in the intimal layer of the sinus causes blood to collect within a false lumen covered by the outer adventitia. They are more likely to occur due to localized intimal disease or trauma during procedures or surgeries. In many cases, a true aneurysm is present before the tear occurs [3, 4]. Obstruction of coronary flow secondary to aneurysms or pseudoaneurysms of the sinus of Valsalva is an uncommon manifestation. The risk of flow disturbance is substantially greater when the left coronary sinus is involved causing compression of the LMCA, left anterior descending and/or left circumflex artery [3, 5, 6].

Repair of Intramural Coronary Artery in Anomalous Aortic Origin of a Coronary Artery

echocardiography for the detailed noninvasive assessment of ALCAPA.

Prevalence of anomalous origin of coronary artery detected by multi-detector computed tomography at one center

To investigate the clinical manifestations and treatment of congenital atresia of the left main coronary artery (CLMCA-A). Four patients were diagnosed to have CLMCA-A from June 2010 to June 2012 in Beijing Anzhen Hospital. Clinical manifestations, ultrasound, ECG and angiographic characteristics were analyzed and summarized. Of the 4 cases, age of onset was 3 months to 2 yrs. Three cases were diagnosed by angiography, and 1 case by CTA . All 4 cases had chronic heart failure symptoms and signs, such as sweating, shortness of breath, easily choked by milk, predispose to pneumonia, activity intolerance. ECG showed abnormal Q wave and other ischemic signs such as ST-T segment depression. Ultrasonography showed left ventricular enlargement, left ventricular systolic function was normal or slightly reduced, and there was moderate to large amount of mitral valve regurgitation. Left ventricular trabeculations increased. Coronary collateral circulation increased. Left coronary artery appeared to be slender and disconnected with left coronary artery sinus. Aortic root angiography was the golden diagnostic standard. Angiography was performed in 3 patients and showed that left main coronary artery had a blind end, diameter 1.1-2.0 mm. The right coronary artery was found rising from the right coronary sinus and visible on coronary collateral circulation. Contrast agent developing sequence: right coronary artery-collateral vessels-left coronary artery distal branches-left main coronary artery. CTA exam was performed in 2 cases and in 1 case the diagnoses was confirmed. All the 4 patients are currently in the close follow-up, digoxin and diuretics were taken everyday and clinical symptoms were improved. CLMCA-A is not rare, its clinical manifestations should be differentiated from those of cardiomyopathy, endocardial fibroelastosis, congenital valvular disease and abnormal left coronary artery originating from pulmonary artery etc. For pediatric patients with cardiac enlargement, abnormal heart function, mitral valve regurgitation etc, attention must be paid to consider the developmental abnormality of coronary artery, particularly the CLMCA-A diagnosis.

Resection of Giant Coronary Artery Aneurysms in a Takayasu's Arteritis Patient

Anomalous origin of either the right or left main coronary artery from the aorta with subsequent coursing between aorta and pulmonary trunk: Analysis of 32 necropsy cases

Objective: Analysis of three cases in which the clinical diagnosis was ruptured sinus of Valsalva aneurysm (RSVA) from left coronary sinus, combined with similar cases in the literature, to summarize the etiology of RSVA. Methods: Retrospective analysis of three cases of RSVA diagnosed in our hospital from 2009 to 2021. Their general condition, examination and treatment were analyzed, and the etiology of the sinus of Valsalva aneurysm (SVA) was summarized in relation to similar cases reported in the literature. Results: All three cases were diagnosed as RSVA from left coronary sinus with a clear etiology of congenital SVA, Behcet’s disease and infective endocarditis, respectively. They all underwent successful surgical treatment. In the literature, there were 12 cases of SVA from left coronary sinus of definite etiology, 10 of which ruptured. Conclusions: SVA from left coronary sinus is a rare disease with a complex etiology, and RSVA is one of the most serious complications of SVA. Exploring the etiology of SVA will help to prevent the serious complications of RSVA by targeting the etiology for treatment and timely surgical intervention.

A 73-year-old woman with a history of hypertension was admitted to the emergency room for chest pain and dyspnea. A chest radiograph showed mediastinal widening and increased cardiothoracic ratio (Figure 1A). Electrocardiography showed normal sinus rhythm without any ST changes (Figure 1B). Preoperative echocardiography was unremarkable except for moderate pericardial effusion. Enhanced computed tomography (CT) revealed acute type A aortic dissection with moderate amount of pericardial effusion and ectopic high origin of the left main coronary artery (LMCA; Figure 1C). Figure 1. The preoperative diagnostic work-ups. A , The preoperative chest x-ray shows mediastinal widening and increased cardiothoracic ratio. B , The preoperative EKG shows normal sinus rhythm without any ST changes. C , Computed tomography shows the ostium of the left main coronary artery to be at ≈28 mm above the aortic valve and moderate amount of pericardial effusion (*). AoV indicates aortic valve; and LM, left main coronary artery. Emergency surgery was performed under cardiopulmonary bypass with cardioplegic arrest. During surgery, we recognized that LMCA originated ≈28 mm above the aortic valve and coursed down extramurally (Figure 2). LMCA was mobilized cautiously and separated from the aortic wall. After …

Left sinus of Valsalva aneurysm causing acute myocardial infarction with compression of the left main coronary trunk

Asymmetric Mechanical Properties of Porcine Aortic Sinuses