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Aneurysm of sinus of Valsalva: cause of dynamic coronary constriction after aortic valvular replacement and bacterial endocarditis.

A patient who had endocarditis on a prosthetic aortic valve and who had undergone two aortic valvular replacements developed classic angina pectoris. Cardiac catheterization revealed an aneurysm of the left sinus of Valsalva, which constricted a proximal segment of the left circumflex coronary artery during systole. This type of dynamic coronary arterial narrowing has not been previously described secondary to an aneurysm of a sinus of Valsalva and may be responsible for this patient's manifestations of ischemia.

Adult

Echocardiographic features of mitral obstruction due to bacterial endocarditis.

We describe a patient with mitral valvular obstruction due to vegetative endocarditis. The diagnosis was made before surgery by M-mode and two-dimensional echo-cardiograms, which revealed a mass of echoes obstructing the mitral orifice. This was confirmed subsequently at surgery. Both modes of echocardiography are of value in the noninvasive diagnosis of mitral valvular obstruction due to vegetative endocarditis, a condition which may be amenable to surgery for valvular replacement.

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