UNRUPTURED ANEURYSM OF THE LEFT SINUS OF VALSALVA EXTENDING INTO THE LEFT-VENTRICULAR OUTFLOW TRACT - PRESENTATION AND IMAGING

The symptomatic presentation of an unruptured sinus of Valsalva aneury sm is rare. A 48 year old man with a history of treated hypothyroidism , and a five year history of ileocolonic Grohn's disease of chronic lo w grade activity presented with a profound left hemiplegia. He was In sinus rhythm and normotensive. Cardiac auscultation was repeatedly nor mal. Computed tomography of the head performed early in the course of the illness was reported as normal. Duplex Doppler examination of the carotid arteries performed six months later revealed no significant at heroma, There was complete resolution of the neurological deficit over a period of months. A year later he presented with chest pain suggest ive of myocardial ischaemia, Computed tomography, magnetic resonance i maging, transthoracic and transoesophageal echocardiography, and cardi ac catheterisation painted to a sinus of Valsalva aneurysm protruding into the left ventricular out-flow tract, In view of the previous neur ological event and ongoing chest pain suggestive of myocardial ischaem ia, the lesion was resected. The patient made a good recovery and post operative transoesophageal echocardiography showed normal aortic valve function with no residual regurgitation. This is the first reported c ase of pure left ventricular outflow tract extension of an unruptured left sinus aneurysm. The presentation with ischaemic cardiac pain does not seem to be explained by conventional mechanisms.