alker and colleagues 1 were the first to define the term "inflammatory aneurysm." They reported 19 cases and found that these aneurysms were nonbacterial special types of atherosclerotic aneurysms. Inflammatory aneurysms constitute approximately 5% of all infrarenal abdominal aortic aneurysms. 2 However, location of these aneurysms in the ascending thoracic aorta is extremely uncommon. 3 Connery and colleagues 4 first described an isolated inflammatory aneurysm in the ascending thoracic aorta. Typical histologic examination shows signs of chronic inflammation in the adventitia with a marked lymphoplasmacytic cell infiltrate and granulation or fibrous tissue proliferation. 5

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We report an unusual case of accessory mitral valve tissue associated with a situs inversus and missing obstruction of the left ventricular outflow tract. To our knowledge our patient is the only elderly patient with an accessory mitral valve with associated situs inversus undergoing surgical resection. The report emphasizes direct cardioscopy through the aortic annulus allowing precise excision of the abnormal tissue.

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A 61-year-old man presented with aortic valve stenosis, coronary artery disease in combination with rheumatic arthritis, peri-aortic inflammation and fibrosis with aortitis. In the pathological literature this has been termed chronic periaortitis, while in the surgical literature, non-aneurysmal dilatation of the aorta associated with atherosclerosis and inflammation has been described as aortitis. The name chronic periarteritis refers to the associated involvement of coronary arteries. Although different terminologies have been used, it is suggested that all of them most likely represent the same disease entity.