Case Report Left Main Compression by a Giant Aneurysm of the Left Sinus of Valsalva: An Extremely Rare Reason for Myocardial Infarction and Cardiogenic Shock Bruno L. R. Faillace, Micheli Z. Galon, Marcos Danillo P. Oliveira, Guy F. A. Prado Jr., Adriano A. M. Truffa, Expedito E. Ribeiro, and Pedro A. Lemos Department of Interventional Cardiology, Heart Institute (InCor), University of S˜ ao Paulo, Avenida Dr. En´ eas de Carvalho Aguiar 44, 05403-900 S˜ ao Paulo, SP, Brazil Correspondence should be addressed to Expedito E. Ribeiro; expribeiro@incor.usp.br Received 29 July 2015; Revised 25 August 2015; Accepted 30 August 2015 Academic Editor: Mohammad R. Movahed Copyright © 2015 Bruno L. R. Faillace et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aneurysms of the sinus of Valsalva are very rare and mostly located in the right coronary sinus. Tey might course with dyspnea, fatigue, and acute coronary syndromes. We present herein an extremely rare case report of a 61-year-old woman diagnosed with external lef main coronary compression by a giant aneurysm of the lef sinus of Valsalva, which was successfully managed with percutaneous coronary intervention. 1. Introduction Aneurysms of the sinus of Valsalva are very rare and mostly located in the right coronary sinus [1], with common protru- sion and rupture to right ventricle and atrium, respectively, and are more related to history of infectious endocarditis (IE) with low mortality rate in stable cases [2]. Tey might course with dyspnea, fatigue, and acute coronary syndromes (ACS) [3, 4]. Clinically recognized myocardial infarction is uncommon in patients with IE and mostly reported as case or series reports [5]. 2. Case Report A 61-year-old female was submitted four years ago to surgical aortic valve replacement (SAVR) with deployment of a bio- logical valvar prosthesis due to native aortic valve endocardi- tis. Tree years afer this procedure, she was admitted to the cardiology emergency department complaining of persistent daily fever and asthenia for the last ten days. Transesophageal echocardiography (TEE) fndings (thickness of the prosthetic leafets, Figure 1) associated with clinical and laboratorial fndings (elevated infammatory markers) were compatible with the Duke criteria [6] for biological aortic prosthesis infectious endocarditis (BAPIE). During the same hospitalization, twenty days afer the antibiotic regimen was introduced, the patient developed hemodynamic instability associated with severe chest pain at rest. Te electrocardiogram showed ST segment elevation in the lead aVR and marked difuse ST segment depres- sion (Figure 2). Emergent coronary angiogram was then performed and evidenced an important luminal narrowing of the distal lef main coronary artery (LMCA) and the proximal portions of the lef anterior descending (LAD) and lef circumfex (LCx) arteries (Figure 3). Due to the refractory hemodynamic compromise, despite the use of high doses of vasopressors and inotropes combined with intra-aortic balloon pumping (IABP) support and invasive mechanical ventilation, it was decided by the percutaneous coronary intervention (PCI). A long metallic stent (3,5 × 28 mm) was then implanted on the LMCA-LAD, which was postdilated with a high pressure noncompliant balloon (4,0 × 15 mm). Afer that, another long metallic stent (3,5 × 28 mm) was deployed through the struts of the previous stent (according to the “T” and small protrusion technique) into the proximal portion of the LCx. A fnal simultaneous kissing balloon Hindawi Publishing Corporation Case Reports in Cardiology Volume 2015, Article ID 703646, 3 pages http://dx.doi.org/10.1155/2015/703646