Acute inferior myocardial infarction due to a large thrombus in the Left Coronary Sinus of Valsalva

Abstract

Background Masses in the ascending aorta are an uncommon source of coronary embolism: thrombi located on atherosclerotic aortic plaques are the most frequent cause. A floating thrombus, without evidence of ascending aortic pathology has rarely been reported Method We report a case of an unusual aortic route thromboembolism leading ST segment elevation Myocardial Infarction (STEMI). The patient was referred to the Hub Hospital to undergo urgent coronarography. The examination excluded atherosclerotic coronary arteries disease but an unusual persistence of contrast dye was found at the level of non-coronary sinus. The trans-esophageal echocardiography showed a mobile pedunculated echogenic mass allocated in the non-coronary sinus of Valsalva, prolapsing into the right coronary ostium and leading his dynamic occlusion at every cardiac cycle. Results The patient underwent emergency cardiac surgery. An enormous thrombotic mass was removed from the left coronary sinus of Valsalva. No tears in the aortic route or aortic valve anomalies were found. He was discharged in good clinical conditions 12 days after his admission. Conclusion This case show the importance of a multidisciplinary approach to a such challenging scenario was successful. It emphasizes the role of heart team in the decision-making algorithm