A case of acute myocardial infarction caused by a giant thrombus derived from an aneurysm of the sinus of valsalva and a bioprosthetic aortic valve

摘要

An 85-year-old woman with a history of aortic valve replace- ment with a bioprosthetic valve (Carpentier-Edwards PERI- MOUNT Magna 23-mm, Edwards Lifesciences, Irvine, CA, USA) 10?years before was referred to the cardiac surgery department by her primary care physician because of an enlarged aneurysm of the sinus of Valsalva (ASV). Contrast- enhanced computed tomography (CECT) and transthoracic echocardiography (TTE) showed no evidence of thrombus (Fig.?1a, b). She was admitted to the emergency department with sudden chest pain three days after preoperative evalua- tion. The patient was in shock and had remarkable bradycar- dia with a heart rate of 36?bpm. Electrocardiogram revealed complete atrioventricular block and ST segment elevation in the inferior leads. TTE showed hypokinesis in the left ventricular inferior wall, as well as in the right ventricular wall. To further investigate the underlying cause of acute myocardial infarction (AMI), the authors performed CECT, which revealed a giant mass attached to the stent strut of the aortic bioprosthetic valve completely occluding the right coronary artery (Fig.?1c). Transesophageal echocardiogra- phy confirmed a mobile mass of 22 × 16?mm 2 fluttering in the enlarged right sinus of Valsalva (Fig.?1d and Online Video 1). Surgical removal of the mass was preferred over percutaneous coronary intervention to avoid further embolic events such as ischemic stroke. Finally, a massive thrombus binding to the bioprosthetic valve was removed, followed by the Bentall procedure. Although she required a right ven- tricular support device (RVAD) because of severe right heart failure, the postoperative course was relatively uneventful. The RVAD was removed on postoperative day (POD) 4 and the patient was discharged on POD 28.