Dilatation of sinus of Valsalva with displacement and compression of the left coronary artery causing sudden death

A 69-year-old male patient is described who presented with angina and congestive heart failure 12 years after his aortic valve had been replaced by a bioprosthesis for aortic stenosis. The aortogram showed massive dilatation of the aortic root. Coronary angiography demonstrated a displaced and narrowed left main and circumflex coronary artery. The patient died suddenly before his scheduled elective operation. At autopsy the left main and circumflex coronary artery were patent but severely compressed by extensive dilatation of the aortic root, predominantly of the left sinus of Valsalva. His sudden death was most likely due to external constriction of the left coronary artery with subsequent ischemia and ventricular fibrillation.