Redundant eustachian valve endocarditis: neonatal diagnosis.

was taken which showed that the aneurysm had increased in size (Figure 1D). Faced with a risk of complications (thrombosis, embolism, rupture) we decided to perform another surgical procedure involving aneurysm resection and derivation of the internal mammary artery to the anterior descending artery (Figure 2). The microbiology culture was sterile and the histological study showed non-specific fibrosis. The patient underwent the operation with no complications and was discharged after 4 months of hospitalisation. One year later, he remains asymptomatic. The natural history and treatment steps are not well defined for arteriosclerotic coronary aneurysms, but they are related to the size and symptoms. Some authors consider that a size >1 cm or 3-4 times the size of the native vessel is an indication for surgery4 or for percutaneous closure by implanting a stent graft. Other authors believe that if the aneurysm is small and does not present severe lesions or complications, the long-term prognosis is good and it can be handled with medical treatment.5 Mycotic aneurysms account for 2% of all coronary aneurysms. In most cases, they are a complication of bacterial endocarditis affecting the aortic and/or mitral valve. The most frequently isolated microorganisms are Staphylococcus aureus and Streptococcus viridans. Small aneurysms may respond favourably to early antibiotic treatment, but surgery is normally necessary to repair them. To date, the publications we reviewed contain no reported cases of mycotic coronary aneurysms caused by S pneumoniae. In our case, we cannot confirm that this is a case of a superinfected aneurysm since the histological study of the cultured sample was negative (after antibiotic treatment), but its rapid growth and the association with purulent pericarditis make infection the most probable diagnosis.