A RARE CASE OF PSEUDOANEURYSM OF THE AORTIC ROOT SIMULATING AN ACUTE CORONARY SYNDROME

Cardiovascular risk factors: arterial hypertension, dyslipidemia, IFG tolerance. In the last two months, onset of swelling edema and exertional dyspnea. Recent hospitalization for congestive heart failure with echocardiographic findings of moderate aortic valve stenosis and left ventricle wall motion abnormalities and EKG signs of myocardial ischemia. At the 24 hours Holter-EKG there was no sustained ventricular tachycardia. Patient was then admitted to our cat lab for a coronarographic examination, which showed functional occlusion of proximal IVA. During catheter placement in the right ventricle, we found evidence of a cavity communicating with aorta with aortic sphygmic wave suggesting a false aortic dissection lumen. After the coronarographic examination, a transthoracic echocardiogram was performed showing a large oval structure (6.6 x 5.47) in contiguity with left Valsalva sinus and with the origin of the left main coronary artery, suggesting the presence of a pseudoaneurysm of the aortic root. This clinical and echocardiographic suspicion was later confirmed by chest CT scan. The patient was subsequently referred to the Cardiac Surgery Department. During surgery, there was evidence of fissuring of the left coronary sinus probably caused by atherosclerotic plaque rupture. This was associated with a large pseudoaneurysm (between aorta and pulmonary trunk) and aortic valve stenosis.