PMC4586899_01
Transesophageal echocardiography images showing thickness of the biological valvar prosthetic leaflets.
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Transesophageal echocardiography (TEE) findings (thickness of the prosthetic leaflets, Figure 1) associated with clinical and laboratorial findings (elevated inflammatory markers) were compatible with the Duke criteria for biological aortic prosthesis infectious endocarditis (BAPIE).
ECG findings: the resting 12 leads electrocardiogram showing the ST segment elevation in the lead aVR with marked diffuse ST segment depression.
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The electrocardiogram showed ST segment elevation in the lead aVR and marked diffuse ST segment depression (Figure 2).
Left coronary artery in RAO caudal projection showing the severe luminal narrowing of the distal LMCA and proximal portions of the LAD and LCx arteries. RAO, right anterior oblique; LMCA, left main coronary artery; LAD, left anterior descending; LCx, left circumflex.
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Emergent coronary angiogram was then performed and evidenced an important luminal narrowing of the distal left main coronary artery (LMCA) and the proximal portions of the left anterior descending (LAD) and left circumflex (LCx) arteries (Figure 3).
Left coronary artery in RAO caudal projection showing the final result after the PCI of the distal LMCA and proximal portions of the LAD and LCx arteries. RAO, right anterior oblique; PCI, percutaneous coronary intervention; LMCA, left main coronary artery; LAD, left anterior descending; LCx, left circumflex.
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The final angiographic result is showed in Figure 4.
Post-PCI computed tomography angiography showing the giant aneurysm involving the three sinuses of Valsalva and its relationship with the major epicardial coronary arteries. PCI, percutaneous coronary intervention; RCA, right coronary artery; LMCA, left main coronary artery; LAD, left anterior descending; LCx, left circumflex.
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One month after the procedure, a computed tomographic scan angiography (CTSA) was performed, demonstrating the giant aneurysm of the sinuses of Valsalva and its relation to the coronary arteries submitted to the implantation of the metallic stents (Figure 5).