Left ventricular outflow tract pseudoaneurysm after aortic valve replacement: case report.

A 68-year-old woman was admitted for angina pectoris and general fatigue without symptoms or signs of infective endocarditis. The patient had undergone re-replacement of an aortic prosthetic valve three months previously. Transesophageal echocardiography revealed an echo-free cavity in the mitral-aortic intervalvular fibrosa region just below the aortic annulus, communication of the echo-free cavity with the left ventricular outflow tract, and turbulent flow into the cavity. Left ventriculography revealed a cavity that arose just below the aortic prosthetic valve, and which expanded in systole and collapsed in diastole. Coronary angiography showed significant stenosis of the proximal right coronary artery, but neither stenoses nor compression were found in the left coronary artery. Patch closure of the pseudoaneurysm and aortic root replacement using a Freestyle valve with reconstruction of the coronary arteries were successfully performed. Surgical trauma to the intervalvular fibrosa during removal of the original prosthetic valve may have caused pseudoaneurysm formation in this patient.

Anomalous origin of the right coronary artery: report of a case.

A 63-year-old man was admitted with a complaint of dyspnea. Echocardiography showed severe aortic regurgitation (AR), and moderate mitral regurgitation (MR). Coronary angiography revealed that the right coronary artery (RCA) arose from the ascending aorta with a high takeoff and a significant stenosis at the distal segment of the RCA. Scintigraphy with Thallium showed a transient perfusion defect on the inferior wall. The diagnosis of AR and MR associated with anomalous origin of the RCA and myocardial ischemia was made. After successful catheter intervention for stenosis of the RCA, an operation was performed on the aortic and mitral valve. At surgery, the orifice of the RCA was located above the commissure of the right and left coronary cusps and the shape was obliquely elliptical. The RCA originated at an acute angle from the ascending aorta, and its proximal segment was incorporated in the wall of the aorta. After aortic valve replacement and mitral valve repair, a neo-ostium without unroofing of the intramural segment of the RCA was created at the proximal RCA, and the intima of the RCA was fixed to the intima of the aorta. The patient recovered uneventfully and is doing well without findings of myocardial ischemia at present 40 months after operation.