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Sinus of Valsalva aneurysm presenting as myocardial infarction during dobutamine stress test
A C Ferreira1, E de Marchena, M Mayor
1Department of Medicine, University of Miami School of Medicine, FL 33136, USA.
Insights
A sinus of Valsalva aneurysm caused myocardial injury during a dobutamine stress test. This case highlights the risks of pharmacologic stress testing in patients with undiagnosed aortic root abnormalities.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Sinus of Valsalva aneurysms are rare congenital or acquired dilations of the aortic root.
- They can remain asymptomatic or present with complications like rupture, dissection, or compression of adjacent structures.
- Pharmacologic stress testing is commonly used to evaluate for coronary artery disease.
Observation:
- A patient undergoing a dobutamine stress test experienced myocardial injury and infarction.
- The patient had an undiagnosed left sinus of Valsalva aneurysm.
- Cardiac catheterization was performed to investigate the cause of myocardial injury.
Findings:
- The left sinus of Valsalva aneurysm was found to be expanding.
- The expanding aneurysm was compressing the circumflex coronary artery.
- This compression led to reduced blood flow and subsequent myocardial infarction.
Implications:
- This case underscores the importance of considering structural cardiac abnormalities, such as sinus of Valsalva aneurysms, when interpreting stress test results.
- Pharmacologic stress testing may precipitate complications in patients with undiagnosed aortic root pathology.
- Increased awareness of these potential complications is crucial for patient safety during cardiac evaluations.
Abstract:
We report a patient with an undiagnosed left sinus of Valsalva aneurysm who, during a dobutamine stress test, had myocardial injury and subsequent infarction. Cardiac catheterization revealed an expanding sinus of valsalva aneurysm compressing the circumflex coronary artery. The clinical manifestations of sinus of Valsalva aneurysm are discussed. This report heightens awareness of the possible effects of the pharmacologic stress test.