Cor Vasa 2024, 66(3):366-369 | DOI: 10.33678/cor.2023.074

Sinus of Valsalva aneurysm - myocardial infarction perpetrator or silent bystander?

Martin Jedlička^a, Michal Fikrle^a, Roman Panovský^{b, c}, Lucia Masárová^{b, c}

^a Department of Cardiology, Jihlava Hospital, Jihlava, the Czech Republic

^b 1^st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital Brno, Brno, the Czech Republic

^c International Clinical Research Center, St. Anne's University Hospital Brno, Brno, the Czech Republic

Background: In some cases myocardial infarction is not associated with atherothrombotic coronary artery dis- ease and can be caused by many different mechanisms. One of these situations is a coronary artery embolism. This case report discusses the possibility of coronary embolism from newly diagnosed sinus of Valsalva aneurysm (SOVA), which is a rare clinical abnormality that can be clinically silent or symptomatic in varied ways. Case presentation: A 54-year-old woman presented with ST-segment elevations myocardial infarction of left ventricle inferior wall. We performed emergent coronary angiography where occlusion of the posterior descending artery was established. This finding was according to the interventional cardiologist's suspicion of embolic etiology. Primary percutaneous coronary intervention was performed. Transthoracic echocardiography suspected of an aneurysm of the right sinus of Valsalva presence. We added coronary computed tomography angiography with confirmation of the SOVA with no thrombi inside. Cardiac surgery with a pericardial patch was performed to solve the SOVA. Unfortunately later postpericardiotomy syndrome appeared which was confirmed by cardiac magnetic resonance. We initiated the therapy of pericarditis with a good effect on the patient's clinical state.

Discussion: In this case angiographic suspicion for coronary embolism in association with newly diagnosed sinus of Valsalva aneurysm led us to consider SOVA as the origin of the embolus. There have been four cases of systemic embolism from SOVA in so far published data mentioned, but no case of embolism from SOVA to coronary circulation has been described. Probability of the embolus origin from SOVA in this case is increased by localization of SOVA beneath the right coronary artery ostium even if we have no evidence of thrombi inside of SOVA. Because there are no official guidelines of SOVA management and there is no stratification scheme of potential SOVA thrombogenicity, there remains a large space for discussion. SOVA thrombogenicity criteria could be a subject for future research. This is the first published case of presumed coronary embolism from SOVA.

Keywords: Case report, Embolism, Myocardial infarction, Sinus of Valsalva aneurysm

Received: September 13, 2023; Revised: September 13, 2023; Accepted: October 1, 2023; Prepublished online: June 2, 2012; Published: June 28, 2024  Show citation