Trans-systolic murmur during the Valsalva maneuver in a patient with apical aneurysm−−−A case report−−−

Yuji Sakanoue, Kanji Iga, Chisato Izumi, Tadashi Miyamoto, Takahisa Kijima, Yoshihiro Himura, Hiromitsu Gen, Takashi Konishi

Summary

We present a 74-year-old female in whom a systolic murmur became trans-systolic during the Valsalva maneuver. The patient had had stable effort angina for these 20 years and coronary angiography revealed complete obstruction of the left anterior descending artery in addition to other atherosclerotic lesions. Left ventriculography showed small apical aneurysm with a narrow oriface. Aorto-coronary bypass surgery and aneurysmectomy were performed; true aneurysm was confirmed pathologically. We conclude that apical aneurysm with a narrow oriface can produce trans-systolic murmur.