Resolution of post-anaesthesia aortic regurgitation by repair of a ruptured sinus of Valsalva aneurysm: 5 case reports

Qian Xue,Chun Yang,Xiu Han

doi:10.1186/s12872-020-01761-1

Abstract

BackgroundRuptured sinus of Valsalva aneurysm (SVA) is a rare cardiovascular disease in which some patients exhibit aortic valve insufficiency. SVA repair and valve replacement are usually required for treatment. Here, we report 5 cases of ruptured SVA with severe post-anaesthesia aortic regurgitation (AR). To the best of our knowledge, this is the first report of ruptured SVA with severe post-anaesthesia AR.Case presentation:From 2018 to 2020, there were 5 cases of ruptured SVA with severe AR after anaesthesia in our hospital. The main symptoms were palpitation and shortness of breath. Transthoracic echocardiography (TTE) with colour-flow Doppler showed ruptured aortic sinus aneurysms without AR. Post-anaesthesia echocardiography showed severe AR. Direct patch closure of the ruptured aneurysm resolved the left-to-right shunt and AR, and the aortic valve was not replaced.ConclusionsPost-anaesthesia AR without obvious structural defects may occur in patients with ruptured SVAs. Valve replacement may not be necessary.

Highlights

Ruptured sinus of Valsalva aneurysm (SVA) is a rare cardiovascular disease in which some patients exhibit aortic valve insufficiency
Post-anaesthesia aortic regurgitation (AR) without obvious structural defects may occur in patients with ruptured SVAs
In 1839, Hope gave the first report of a ruptured SVA, which occurred in a 25-year-old patient [1]

Summary

Background

Sinus of Valsalva aneurysm (SVA) is a rare cardiovascular disease. In 1839, Hope gave the first report of a ruptured SVA, which occurred in a 25-year-old patient [1]. The present study includes 5 patients with ruptured SVAs who experienced severe aortic regurgitation (AR) after anaesthesia. Case presentation From 2018 to 2020, there were 5 cases of ruptured SVA with severe post-anaesthesia AR in our hospital. The patients came to the hospital for treatment due to palpitations and shortness of breath. Transthoracic echocardiography (TTE) with colour-flow Doppler showed ruptured aortic sinus aneurysms without AR. Four patients had a noncoronary sinus that had ruptured into the right atrium, and. 1 patient had a right sinus of Valsalva that had ruptured into the right ventricle (Fig. 1). TTE and transoesophageal echocardiography (TEE) showed aortic insufficiency with severe regurgitation (Fig. 2). Because preoperative TTE showed no AR, we decided to repair the ruptured SVA without valve replacement and observe the change in valve regurgitation. Three months after discharge from the hospital, TTE confirmed that there was no AR

Discussion

Conclusions