Aneurysm of the sinus of Valsalva associated with coarctation.

Abstract

The presence of aortic sinus aneurysm has been reported in the recent literature with especial reference to the notable clinical events brought about by rupture of the aneurysm (1-3). Most often syphilis and bacterial endocarditis are the underlying causes. Aortic sinus aneurysm may occur, however, as a congenital anomaly. With the increasing use of angiocardiographic studies in heart disease, the existence of such aneurysms, on both an acquired and congenital basis, has been demonstrated (1, 2, 4, 5). In the case to be reported here, an aortic sinus aneurysm was associated with coarctation of the aorta. Case Report J. T., a 21-year-old white female, had been examined repeatedly since the age of six, when following a febrile illness she was said to have heart murmurs, which were attributed to rheumatic fever. She had never suffered symptoms of cardiac decompensation, however, and was able to engage in all school athletic activities. During a recent routine examination, hypertension of 180/100 was noted in both upper extremities and an absence of pulses in the lower. So far as the patient knew, her blood pressure had been normal previously. General physical examination was not remarkable except for the cardiovascular findings. The heart was enlarged to 2 em. outside the mid-clavicular line in the sixth intercostal space. The first heart sound was forceful, and a prolonged rough systolic murmur was heard at the base, transmitted into the neck as well as interscapularly posteriorly. A softer systolic murmur was detected at the apex, with spread into the left axilla, and a faint early diastolic blow was heard over the base, with transmission down along the left sternal border. A systolic thrill was elicited over the aortic area, and the second aortic sound was markedly increased. Blood count, urinalysis, and electrocardiogram were normal. A chest film (Fig. 1) and fluoroscopy revealed left ventricular enlargement and minimal evidence of notching of the posterior ribs. Angiocardiography (Fig. 2) demonstrated a coarctation of the aorta in the descending arch and an aneurysm of the right aortic sinus measuring 4.4 X 5.0 em. The coarctation was excised by Drs. Roy Cohn and George Armanini. No abnormality of the cardiac surface suggesting aneurysmal dilatation was seen. The postoperative course was uneventful. Three months following surgery, blood pressure was 128/74 in the upper extremities, 110/70 in the right leg, and 130/90 in the left leg. The cardiac apex beat was now felt in the mid-clavicular line. The harsh systolic murmur at the base had diminished in intensity, as had the apical murmur. The second aortic sound was less forceful, and the early diastolic murmur was no longer audible. A chest film at this time showed slight decrease in heart size.