Aneurysm of sinus of Valsalva: cause of dynamic coronary constriction after aortic valvular replacement and bacterial endocarditis.

A patient who had endocarditis on a prosthetic aortic valve and who had undergone two aortic valvular replacements developed classic angina pectoris. Cardiac catheterization revealed an aneurysm of the left sinus of Valsalva, which constricted a proximal segment of the left circumflex coronary artery during systole. This type of dynamic coronary arterial narrowing has not been previously described secondary to an aneurysm of a sinus of Valsalva and may be responsible for this patient's manifestations of ischemia.