290 A UNIQUE CASE OF AORTIC VALVE LEAFLET'S ANEURYSM DETECTED BY CARDIAC COMPUTED TOMOGRAPHIC ANGIOGRAPHY-CCTA


 Heart valve leaflet's aneurysm is a rare finding and literature about this topic is sparse. Early recognition is important because their rupture can lead to catastrophic valve regurgitation.
 An 84 years old male with chronic ischemic cardiomyopathy was admitted to coronary-intensive-care-unit for non-ST-elevation-myocardial-infarction. Baseline transthoracic-echocardiography showed normal biventricular function with inhomogeneous thickening of aortic leaflets with moderate aortic regurgitation. Because acoustic window was limited, a trans-esophageal echocardiography was performed detecting a small mass in the right aortic coronary cusp with moderate regurgitation (orifice regurgitation area: 0,54 cm2; med/max gradient: 16/32 mmHg). Endocarditis was ruled out. Because of the rapid worsening of patient's conditions, requiring mechanical ventilation and hemofiltration, and the potential hazard of an urgent coronary angiography, a cardiac computed tomographic angiography (CCTA) was performed. Detailed spatial reconstructions highlighted a bilobed cavitation in the commissure between right-left aortic coronary cusps. Diagnosis of aortic leaflets’ aneurysm was made. A “wait and see” strategy was chosen and patient's general conditions gradually improved and now he is stable and uneventful. To date no aortic leaflet's aneurysm were described in literature.