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The following electronic only articles are published in conjunction with this issue of Heart.

Unruptured congenital aneurysm of the left sinus of valsalva in an adult with complex left heart malformations

A Hakami, B Stiller, R Hetzer

A 26 year old man who presented with the first signs of right heart failure was found to have a large congenital aneurysm of the aortic sinus of Valsalva and of the left coronary sinus. These were combined with left heart anomalies in the form of a bicuspid aortic valve, a rare variant of a persistent left superior vena cava with blood flow from the left atrium through the brachiocephalic vein into the superior vena cava and a kink in the aortic arch. An aortic coarctation had been corrected with a patch 12 years earlier. Although the aneurysm was not perforated and there were no clinical signs of infarction, the aneurysm was resected prophylactically and the left coronary artery was reinserted through a bypass with a Gore-Tex conduit. The case is noteworthy because this diagnosis is very rare and its early treatment may prevent several complications. The clinical features, treatment, and outcome are discussed.

(Heart 2003;89:e3)

Coronary artery aneurysm with a fistulous connection to the right atrium mimicking a sinus of valsalva aneurysm

V Shrivastava, E Akowuah, G J Cooper

Coronary artery aneurysms are uncommon and may be complicated by rupture, thromboembolic phenomenon, and more rarely fistulation into one of the cardiac chambers. This case report highlights the difficulty in making a preoperative diagnosis of a coronary artery aneurysm that has fistulated into the right atrium and lists possible differential diagnoses.

(Heart 2003;89:e4)

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