An Operated Case of Annulo-Aortic Ectasia with Massive Sinuses of Valsalva Presenting with Coronary Insufficiency.
10.4326/jjcvs.28.105
- VernacularTitle:著明なＶａｌｓａｌｖａ洞拡大により右冠状動脈狭窄を来した大動脈弁輪拡張症の一手術例
- Author:
Ko Tanaka
;
Takemi Kawara
;
Atsushige Oryoji
;
Kenichi Kosuga
;
Shigeaki Aoyagi
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
1999;28(2):105-108
- CountryJapan
- Language:Japanese
-
Abstract:
An unusual case of a 71-year-old man with massive sinuses of Valsalva presenting with coronary insufficiency was reported. Primarily, he had undergone aortic valve replacement (AVR) with a diagnosis of severe aortic regurgitation (AR) and annulo-aortic ectasia (AAE). Four years after the primary operation, he came to our hospital as an emergency admission complaining of chest pain. Electrocardiography showed sinus rhythm with ST wave elevation in limb leads of II, III and aVF and a diagnosis of acute myocardial infarction was made. Coronary angiography revealed right coronary insufficiency and aortography showed massive sinuses of Valsalva (diameter 8.5cm) with minimal functional AR. At the second operation, the right coronary artery was severely stretched and attenuated over the surface of the right coronary sinus. The ostium was found to be free of atherosclerosis. A composite reconstruction of the aortic root with a new valved conduit and reimplantation of coronary arteries were performed. The postoperative course was uneventful. Aneurysmal change of the sinus of Valsalva is rare, and it is reported that the mean maximal diameter is 5.4cm in this type of AAE. In our case, the unusual dilation of the sinuses of Valsalva resulted in right coronary insufficiency. This case reminded us that aortic root replacement must be applied in patients with AAE as the initial treatment of choice.
