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The aneurysms of sinus of Valsalva are rare cardiac anomalies, which may be either acquired or congenital. A congenital lack of continuity between the aortic media and annulus fibrosus may initiate aneurysm formation. Acquired aneurysms may result from trauma, endocarditis, syphilis, Behcet, atherosclerosis and senile-type dilatation. We report a case of a 38-year-old man who presented with aneurysm of the right sinus of Valsalva with fistula between it and the right ventricular outflow and pulmonary trunk dilatation diagnosed by transthoracic echocardiography (TTE), chest computed tomography (CT) scan and transesophageal ecocardiography (TEE). We describe this case which has been successfully-treated because the concomitant presence of an aneurysm of the right Valsalva sinus, a fistula between it and the right ventricular outflow and pulmonary trunk dilatation represents an extremely rare and poorly described event in the literature.

Current international guidelines strongly recommend the use of high-intensity lipid-lowering therapy (LLT) after hospitalization for atherosclerotic cardiovascular disease (ASCVD) events. With this study, our aim was to evaluate LLT prescribing in a large Italian cohort of patients after discharge for an ASCVD event, exploring factors associated with a lower likelihood of receiving any LLT and high-intensity LLT. Individuals aged 18 years and older discharged for an ASCVD event in 2019–2020 were identified using hospital discharge abstracts from two local health units of the Campania region. LLT treatment patterns were analyzed in the 6 months after the index event. Logistic regression models were developed for estimating patient predictors of any LLT prescription and to compare high-intensity and low-to-moderate-intensity LLT. Results: A total of 8705 subjects were identified. In the 6 months post-discharge, 56.7% of patients were prescribed LLT and, of those, 48.7% were high-intensity LLT. Female sex, older age, and stroke/TIA or PAD conditions were associated with a higher likelihood of not receiving high-intensity LLT. Similar predictors were found for LLT prescriptions. LLT utilization and the specific use of high-intensity LLT remain low in patients with ASCVD, suggesting a substantial unmet need among these patients in the contemporary real-world setting.