Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:44 - Vol. 71 Num.01 DOI: 10.1016/j.rec.2017.08.016

Thrombosis of a Valsalva Sinus Aneurysm Causing AMI

Juan A. Herrador a,, Víctor Aragón a, Juan C. Fernández a

a Servicio de Cardiología, Complejo Hospitalario de Jaén, Jaén, Spain

Article

A 30-year-old male smoker of 20 cigarettes a day presented with a 1-hour history of chest tightness. ST elevation of 2 mm was observed in the inferior leads of the electrocardiogram.

Emergency catheterization via the right radial artery was performed and a right Valsalva sinus aneurysm (VSA) was detected on angiography. The lesion was elongated and measured 13 mm across, with extensive thrombotic material, but the right coronary artery (RCA), which was occluded at its origin, was not visualized (Figure 1).

Figure 1.

After a guide catheter was inserted into the RCA, the proximal segment was predilated and a 4 x 28 mm nondrug-eluting stent was implanted from the ostium (Figure 1). Intravascular ultrasound showed correct stent apposition and a large amount of thrombotic material in the VSA (Figure 1). It was decided to administer a fibrinolytic agent (tenecteplase) and perfuse tirofiban.

The patient's clinical outcome was satisfactory. At 24 hours, chest computed tomography was performed, and the morphology of the aneurysm could be determined (27 x 14 mm). No thrombotic remnants were apparent (Figure 2 and Figure 2) and the RCA was patent (Figure 2). The echocardiogram showed inferior hypokinesis and VSA free of thrombotic remnants (Figure 2).

Figure 2.

The patient was discharged after 5 days with warfarin and dual antiplatelet therapy. He was referred for surgical correction.

VSA is a rare cardiac defect that is usually congenital. The most frequent complication is rupture, but rare cases of thrombosis have also been reported, as in our case, leading to coronary ischemia and requiring emergency intervention.

Corresponding author: juanhefu@yahoo.es

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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