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Eur J Cardiothorac Surg 2006;29:840
© 2006 Elsevier Science NL

Images in cardio-thoracic surgery

Unusual cause of myocardial ischemia noninvasively assessed with ECG-gated computed tomography coronary angiography

Francesca Pugliese * , Willem B. Meijboom, Filippo Cademartiri, Gabriel P. Krestin

Department of Radiology and Cardiology, Erasmus Medical Center, Dr. Molenwaterplein 40, 3015GD Rotterdam, The Netherlands

Received 6 January 2006; received in revised form 9 February 2006; accepted 10 February 2006.

* Corresponding author. Tel.: +31 10 46 33558; fax: +31 10 46 34033. (Email: francesca.pugliese{at}libero.it; pndj7571{at}yahoo.com).

Key Words: Valsalva sinus • Coronary aneurysm • Myocardial ischemia

A 71-year-old otherwise healthy woman presenting with atypical chest pain and inconclusive ECG-treadmill test was referred for ECG-gated, 64-detector row computed tomography to study coronary arteries noninvasively (Figs. 1 and 2 ; ).


Figure 1
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  		Fig. 1. Volume-rendered ECG-gated CT image showing a right valsalva sinus aneurysm (asterisk). Ao: aorta; PA: pulmonary artery; LV: left ventricle; RV: right ventricle.

 

Figure 2
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  		Fig. 2. Curved multiplanar reconstruction (curvedMPR) of the right coronary artery (RCA) and multiplanar reconstructions (A–C) obtained as indicated in Fig. 1. On the curvedMPR, the proximal RCA is critically narrowed due to the presence of the aneurysm (asterisk), which is seen bulging between the right ventricle (RV) and the aortic root (Ao) on multiplanar reconstructions (A–C). Thick eccentric thrombus is layered on the ectatic walls. As shown in (A), the ostium of the RCA opens at the level of the aneurysmal neck. No signs of rupture can be seen. The patient underwent uneventful surgery. The RCA was revascularized with a venous graft. Asterisk: aneurysm; Ao: aorta; LA: left atrium; LV: left ventricle; RV: right ventricle; RVOT: right ventricular outflow tract; PA: pulmonary artery.

 
Non-ruptured valsalva aneurysms do not usually cause cardiac dysfunction. However, coronary insufficiency may eventually develop with the expanding sinus.

Appendix A

Supplementary data

Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.ejcts.2006.02.028





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