A 21-year-old woman with a history of progressive exertion dyspnea, fatigue and mild chest pain lasting 1 year and worsening 1 month before progressing quickly for minimum effort dyspnea, orthopnea and paroxysmal nocturnal dyspnea. She denied past of rheumatic fever and repeated pharyngitis. Transesophageal echocardiogram (ETE) evidenced an important subvalvar aneurysm in the left ventricle with severe mitral regurgitation, without suggestive images of thrombus in its interior. A coronary showed dynamic narrowing of up to 75% of the left main coronary artery (LMCA), the left anterior descending artery (LAD) in communication with aneurysm structure with thrombus in its initial portion and circumflex artery (Cx) with narrowing of 75-90% that was attributed to an extrinsic compression caused by the above mentioned subvalvar aneurysm. A surgical procedure was indicated but was refused, both by the patient and by her family; such refusal evolved into death 30 days after.
Heart aneurysm; Coronary vessels; Coronary angiography; Mitral valve insufficiency; Heart failure, congestive
