ANEURYSM OF THE LEFT SINUS OF VALSALVA - AN UNUSUAL SOURCE OF CEREBRAL EMBOLISM

Background Aneurysm of the ascending aorta is rarely reported as the s ource of emboli. We report a patient with a minor stroke in whom a sac cular aneurysm of the left sinus of Valsalva was diagnosed as the pres umed source of cerebral embolism. Case Description A 49-year-old right -handed woman presented 10 days after sudden onset of right-sided hemi paresis. Her history was uneventful apart from an acute inflammation o f the subcutaneous tissue in the right leg 20 years earlier. A diastol ic murmur was heard best over the third left intercostal space. Result s of duplex ultrasound investigation of the cerebral vessels, chest x- ray, and electrocardiography and biochemical and hematological variabl es were normal. CT of the brain showed a small hypodense area in the l eft frontal region. Transthoracic and transesophageal echocardiography detected moderate aortic regurgitation and a saccular aneurysm origin ating from the left sinus of Valsalva. The aneurysm had calcified wall s and contained thrombotic material. Surgical closure of the aneurysm with a pericardial patch was performed to prevent recurrent embolism a nd rupture. Coaptation of the aortic valves was achieved, and no resid ual aortic regurgitation could be detected. Conclusions We conclude th at an unruptured sinus of Valsalva aneurysm should be included in the list of sources of embolism. Transthoracic echocardiography establishe s the diagnosis. Transesophageal echocardiography provides additional information about the origin and size of the aneurysm and presence of thrombotic material. Surgical closure of the aneurysm prevents rupture and recurrent embolism and possibly corrects aortic regurgitation.