[Triple aneurysm of the Valsalva sinus complicated by right coronary occlusion: apropos of a case and review of the literature]

Abstract

We report a case of aneurysm of all three aortic sinuses. The patient suffered from both cardiac failure and angina pectoris. The diagnosis, suggested by echocardiography, was confirmed by magnetic resonance imaging (MRI) which showed marqued dilatation of all three aortic sinuses. At operation, we observed dilatation of all three aortic sinuses, measuring 2 to 6 cm and partially thrombosed. We performed a Bentall operation with reimplantation of the left coronary artery ostium. The right coronary ostium was thrombosed and was revascularized by a saphenous vein bypass. Despite prolonged circulatory assistance and an intra-aortic balloon counterpulsation, cardiopulmonary bypass could not be stopped and the patient died. This is a new case of multiple aneurysms of the aortic sinuses and also a case of aortic sinus aneurysm (ASA) complicated by coronary insufficiency. This last complication has a poor prognosis, as demonstrated by a review of the 28 cases described in the literature. MRI was found to be important for the diagnosis of the ASA, in combination with echocardiography and angiography which can underestimate the aneurysm because of the frequently associated mural thrombus.