A different kind of aneurysm

摘要: A 43-YEAR-OLD white woman was admitted with a preoperative diagnosis of sinus Valsalva aneurysm. In 1979, 22 years before this admission, she had been diagnosed Staphylococcus aureus endocarditis and underwent aortic valve replacement Bjork-Shiley mechanical valve. 1998, 19 later, developed hemodynamically significant regurgitation. At that time, transesophageal echocardiogram showed the presence large perivalvular leak noncoronary The replaced 21-mm St. Jude prosthesis, aneurysm obliterated. postoperative course uneventful. months hospitalization, patient began experiencing worsening episodes palpitations. transthoracic mild mitral regurgitation, tricuspid trace insufficiency Cardiac catheterization aortography confirmed existence posterior pinhole fistula to left atrium. Ventriculography not performed, however, because prosthetic taken operating room for repair She anesthetized, after endotracheal intubation, 7-MHz multiplane