Unusual cause of acute coronary syndrome: dynamic coronary compression by an aortic pseudoaneurysm

A 77-year-old man was admitted to our institution for acute coronary syndrome (ACS) with anterior ST depression on EKG and troponin rise. He had a history of aortic valve endocarditis 4 years earlier, treated with aortic valve replacement using a homograft. Close follow-up was arranged for a silent aortic pseudoaneurysm that developed early after surgery without evidence of recurrent infection. Two bare metal stents were implanted 6 months earlier in the setting of ACS. He was admitted for recurrent chest pain. Coronary angiogram showed a prolonged and critical systolic compression of the …