Myocardial dissection caused by Takayasu’s arteritis complicated with sinus of Valsalva aneurysm

A 58-year-old man presented with dyspnoea and dizziness for 1 month was admitted to our hospital. Physical examination revealed a 3/6 diastolic murmur at left sternal edge. The electrocardiogram (ECG) showed ST-segment depression in lead V4-6. Transthoracic echocardiography showed severe aortic insufficiency and a 46 mm × 32 mm aneurysm at the parasternal aortic short axis view that originated from left sinus of Valsalva (Panels A and B). Coronary artery angiography demonstrated mild compression of left coronary artery (Panel C, Supplementary data online, Video S1). Cardiac computed tomography (CCT) revealed myocardial dissection (MD) between the anterior wall of left ventricle and ventricular septum without shunt and mild left coronary artery compression (Panels D–G). Computed tomography angiography showed circular thickening of aorta (Panel L) and left common carotid artery stenosis (Panel M). Laboratory examination identified with erythrocyte sedimentation rate of 97 mm/h, C reactive protein of 19.8 mg/L, and antistreptolysin O of 938 IU/mL. Subsequently, he underwent operation after the diagnosis of Takayasu’s arteritis was made. Intraoperative view revealed an intimal tear below the opening of left coronary artery and dissected into the left ventricle wall (Panels N and O). Finally, we performed Bio-Bentall procedure and repaired the intimal tear by bovine pericardial patch (Panels P and Q). The pathological analyses of ascending aorta and aortic valve showed proliferation of fibrous tissue with chronic inflammatory cell infiltration (arrow), hyaline, and mucoid degeneration (Panels R and S). Postoperative CCT showed disappearance of MD and left coronary artery compression (Panels H–K). His symptom was relieved obviously and received steroid therapy.