Heart 1998;80:190-193 ( August )
Case study
Unruptured aneurysm of the left sinus of Valsalva extending into
the left ventricular outflow tract: presentation and imaging
a Department of
Cardiology, York District Hospital, Wigginton Road, York YO3 7HE, UK, b Department of
Cardiothoracic Surgery, Yorkshire Heart Centre, Leeds General
Infirmary, Great George Street, Leeds LS1 3EX, UK, c Department of Radiology, Yorkshire Heart Centre
Correspondence to: Dr C Pepper, Department of Cardiology, G Floor, Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
Accepted for publication 15 December 1997
The symptomatic presentation of an unruptured sinus of
Valsalva aneurysm is rare. A 48 year old man with a history of treated hypothyroidism, and a five year history of ileocolonic Crohn's disease
of chronic low grade activity presented with a profound left
hemiplegia. He was in sinus rhythm and normotensive. Cardiac auscultation was repeatedly normal. Computed tomography of the head
performed early in the course of the illness was reported as normal.
Duplex Doppler examination of the carotid arteries performed six months
later revealed no significant atheroma. There was complete resolution
of the neurological deficit over a period of months. A year later
he presented with chest pain suggestive of myocardial ischaemia.
Computed tomography, magnetic resonance imaging, transthoracic and
transoesophageal echocardiography, and cardiac catheterisation
pointed to a sinus of Valsalva aneurysm protruding into the left
ventricular outflow tract. In view of the previous neurological event
and ongoing chest pain suggestive of myocardial ischaemia, the lesion
was resected. The patient made a good recovery and postoperative
transoesophageal echocardiography showed normal aortic valve function
with no residual regurgitation. This is the first reported case of pure
left ventricular outflow tract extension of an unruptured left sinus
aneurysm. The presentation with ischaemic cardiac pain does not seem to
be explained by conventional mechanisms.
© 1998 by Heart
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