Sinus of Valsalva Aneurysm and Multiple Aortic Aneurysms Provoked by Viral Myocarditis.

A 27-year-old male, who was cured from viral myocarditis 6 years ago, was admitted to our clinic with chest pain.

Echocardiography showed regional wall motion abnormalities in the territories of left anterior descending artery (LAD) and aneurismal dilatation of the left coronary sinus of Valsalva. Transesophageal echocardiography revealed that the outpouching structure with mural thrombus arose from the left coronary sinus of Valsalva. Distal to the right coronary ostium, the aorta formed 2 outpouching structures (Figure 1A and B, Supplementary Movies 1 and 2). To evaluate another aneurismal change, computed tomography (CT) was performed and revealed another outpouching structure at descending aorta (Figure 1C and D). The laboratory tests completely ruled out any evidence of current inflammatory disease or autoimmune disease. The history of prior myocarditis was thought to be the cause of multiple aneurysms, as multiple aneurysms were developed after prior myocarditis. CT revealed that the left coronary ostium was originated from the aneurismal wall (Figure 1E and F). The LAD was stenosed due to thrombus migrated from the thrombosed sinus of Valsalva aneurysm. Although we strongly recommended surgical treatment, the patient refused it.

Figure 1

(A) Transesophageal echocardiography revealed that the outpouching structure with mural thrombus arose from the left coronary sinus of Valsalva. (A and B) Distal to the right coronary ostium, the aorta formed another 2 outpouching structures. (C and D) CT revealed another outpouching structure at descending aorta. (E and F) Cardiac multi-detector CT revealed that the left coronary ostium was originated from the aneurismal wall.

CT = computed tomography; LCC = left coronary cusp; LM = left main artery; NCC = non-coronary cusp; RCC = right coronary cusp. *Aneurysm.

Acquired forms of sinus of Valsalva aneurysms may be associated with the conditions affecting aortic wall, such as inflammation and degenerative change.1)2) In the present case, inflammatory reaction triggered by prior myocarditis may progress to aortitis and propagate the aneurysmal change of sinus of Valsalva and aortic wall. The present case implicated that in the patients with multiple aneurysms of aorta, the whole aorta should be evaluated for another aneurysm.