Repair of Sinus of Valsalva Aneurysm

Abstract

We report a case of uneventful repair of Sinus of Valsalva aneurysm (SVA) in a young female without a PA catheter, which can be difficult to place because of the anatomy of the SVA and potentially hazardous by causing serious arrhythmia. INTRODUCTION Sinus of Valsalva aneurysm (SVA) was first described by John Thurman in 1940. SVA is a rear congenital anomaly, which usually is clinically silent but may vary from middle, asymptomatic dilation detected in routine 2-dimentional echocardiography to symptomatic presentation related to the compression of adjacent structures or intracardiac shunting caused by rupture of SVA into the right side of the heart. When SVA ruptures, few specific signs of left-to-right shunting may become apparent. A loud superficial “machine type” continuous murmur is accentuated in diastole A palpable thrill along the right or left lower parasternal border may be presented. Most ruptured SVAs occur from puberty to the age of 30 years and often are diagnosed or presented clinically at this age. A ruptured SVA progresses in 3 stages as described by Blackshear and colleagues (1 ): Acute chest or right upper quadrant pain Subacute dyspnea on exertion or at rest Progressive cough, peripheral edema Atypically SVA presents with infective endocarditis, which may originate at the ages of aneurysm. Approximately 65-85% of SVAs originate from the right sinus of Valsalva, 5% from left sinus (2 ). Congenital SVA is more prevalent in Asia, caused by dilation, usually of a single sinus of Valsalva, from a separation between the aortic media and annulus fibrosis. Rupture of the dilated sinus may lead to the intracardiac shunting with communication to the right atrium (10%) or directly into the right ventricle (60-90%). Cardiac tamponade may occur if the rupture involves the pericardial space. Associated structural defects in congenital SVAs included supracristal or perimembranous VSD (30-60%), bicuspid aortic valve (15-20%) or AR (44-50%).