Rupture of Sinus of Valsalva Aneurysm into Interventricular Septum: Role of Cardiac CT.

Abhishek Jain,Gayathri Achuthan

doi:10.7759/cureus.5589

Abstract

Sinus of Valsalva aneurysm dissecting and forming sinus tract into interventricular septum is an extremely rare complication of sinus of Valsalva aneurysm. Echocardiography and conventional angiography were used earlier to diagnose ruptured sinus of Valsalva aneurysm. Cardiac CT has emerged as a valuable non-invasive diagnostic tool for evaluation of complications of sinus of Valsalva aneurysm. In this article, we report two cases of ruptured sinus of Valsalva aneurysm arising from right and left coronary sinuses into the interventricular septum without aorto-cardiac shunt formation evaluated using 256 slice cardiac CT imaging. After diagnosis on cardiac CT, these findings were confirmed perioperatively and were repaired surgically.

Highlights

Fatal complications are seen with both ruptured and non-ruptured Valsalva sinus aneurysms; after treatment the prognosis is excellent [1]
We report two cases of ruptured sinus of Valsalva aneurysm arising from right and left coronary sinuses into the interventricular septum without aorto-cardiac shunt formation evaluated using 256 slice cardiac computed tomography (CT) imaging
Most Valsalva sinus aneurysms are seen on echocardiography, electrocardiographically (ECG)gated computed tomography (CT) can provide fine delineation of the relevant anatomy as well as associated complications

Summary

Introduction

Fatal complications are seen with both ruptured and non-ruptured Valsalva sinus aneurysms; after treatment the prognosis is excellent [1]. There was a rent in the antero-inferior wall of aneurysm with rupture into the inter-ventricular septum in mid and basal segments (Figures 2-5). CT: Computed tomography; Curved arrow: Right coronary artery; RV: Right ventricle; LV: Left ventricle. Subsequent evaluation with multi slice cardiac CT revealed a fusiform right coronary sinus of Valsalva aneurysm (Figure 7). This was seen to dissect into the basal and mid part of interventricular septum forming a sinus tract with tiny peripheral ramifications (Figures 8-11). CT: Computed tomography; RV: Right ventricle; Curved arrow: Right coronary artery; Straight white arrow: Left coronary artery. The CT showed a large wide mouthed bilobed thick walled outpouching arising from the lateral basal wall of the left ventricle suggestive of left ventricular saccular aneurysm. The patient later underwent an elective surgery for aneurysmal repair and the CT findings were confirmed (Figure 12)

Discussion

Conclusions

Disclosures

Findings

Warthen RO