Aneurysmal pouch on left coronary cusp accompanied by bacterial endocarditis

Abstract

A 58-year-old male was admitted to our hospital with a preliminary diagnosis of bacterial endocarditis. After admission, echocardiography indicated the presence of vegetation-like tissues on both the left coronary cusp and the anterior mitral leaflet, although retrograde aortography two months earlier hadn't indicated an abnormal finding on the aortic cusp. The vegetation-like tissues had gradually enlarged despite the administration of antibiotics at another hospital, and aortic and mitral regurgitation had become severe. We decided to perform replacements of the aortic and mitral valves on the day of admission. During the operation, the aortic valve was found not to have vegetation, but an aneurysmal pouch on the left coronary cusp. It was supposed that either bacterial endocarditis or catheter injury had made a part of the aortic cusp weak and intolerant of diastolic pressure gradient, and as a result, the weakened part of the cusp progressively dilated into the left ventricle forming an aneurysmal pouch. To our knowledge, there have been only two previous reports of an aneurysmal pouch on the aortic cusp documented in the literature.

Aortic valve aneurysm associated with infective endocarditis: case report and review of literature

“…Morimoto et al [2] explained in detail that hematoxylin-eosin staining sections of the aneurysmal wall showed that the middle layer of the non coronary cusp was dissected and its surface was covered with dense fibrin. Other microscopic examinations revealed that the elastic fibers of the cusp were disrupted [8,13]. The histopathological analysis in our case demonstrated active inflammatory changes, and the etiology of this aortic valve aneurysm was presumed to be infective endocarditis.…”

“…We found 17 surgical cases of aortic valve aneurysms [2,[4][5][6][7][8][9][10][11][12][13][14][15][16], these are summarized in Table 1, with the addition of our case.…”

Dynamic Aortic Pouch: A Rare Etiology of Aortic Regurgitation

“…Dilation of the ascending aorta may be due to aortoannular ectasia, Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, aortic dissection, syphilitic aortitis, connective tissue diseases, and idiopathic aortic root dilation [Enriquez-Sarano 2004;Bekeredjian 2005]. We found reports of aneurysms affecting the aortic valve and leading to AR [Makayama 1998;Raval 2002;Sasaki 2002;Halkos 2004;Alkadhi 2007], but no reports of a structure like that in our patient.…”

Aortic valve aneurysm responsible for acute congestive heart failure and histological findings: A case report

“…An aortic valve aneurysm is much less frequent than a mitral valve aneurysm and is an uncommon complication of infective endocarditis [1]. Furthermore, the aortic valve aneurysm in this patient had not only perforated into the left ventricle and exacerbated AR, but also caused LV outflow obstruction, both of which resulted in the progression of congestive heart failure.…”