TRIPLE ANEURYSM OF THE AORTIC SINUS COMPL ICATED BY RIGHT CORONARY-ARTERY OCCLUSION - CASE-REPORT AND REVIEW OF THE LITERATURE

We report a case of aneurysm of all three aortic sinuses. The patient suffered from both cardiac failure and angina pectoris. The diagnosis, suggested by echocardiography, was confirmed by magnetic resonance im aging (MRI) which showed marquet dilatation of all three aortic sinuse s. At operation, we observed dilatation of all three aortic sinuses, m easuring 2 to 6 cm and partially thrombosed. We performed a Bentall op eration with reimplanatation of the left coronary artery postium. The right coronary ostium was thrombosed and was revascularized by a saphe nous vein bypass. Despite prolonged circulatory assistance and an intr a-aortic balloon counterpulsation, cardiopulmonary bypass could not be stopped and the patient died. This is a new case of multiple aneurysm s of the aortic sinuses and also a case of aortic sinus aneurysum (ASA ) complicated by coronary insufficiency. This last complication has a poor prognosis, as demonstrated by a review of the 28 cases described in the literature. MRI was found to be important for the diagnosis of the ASA, in combination with echocardiography and angiography which ca n underestimate the aneurysm because of the frequently associated mura l thrombus.