Coronary Sinus Of Valsalva Research Articles

Anomalous Origin of Left Coronary Artery From the Right Coronary Sinus of Valsalva and Hypoplastic Left Anterior Descending Artery Presenting With Inferior Wall Myocardial Infarction: An Extremely Rare Combination of Congenital Coronary Artery Anomalies

Abstract Coronary artery anomalies are rare congenital disorders diagnosed incidentally during coronary artery angiograms or post-mortem examinations. The prevalence of single coronary artery (SCA) anomalies in the general population is approximately 0.024% according. Here, we report a rare case of SCA incidentally detected during management of the acute coronary syndrome.

A customized technique for confluent aortic annular and selective sinus of Valsalva endocarditis.

We describe a novel technical modification for reoperative aortic valve replacement in destructive recurrent prosthetic aortic valve endocarditis. We encountered complex anatomy in a previously operated aortic root wherein the aortic annulus and the right coronary sinus of Valsalva were destroyed. This precluded secure suture placement. We modified a composite mechanical Valsalva conduit to create a separate sinus of Valsalva left in continuity with the mechanical valve. This approach allowed us to exclude the infected right sinus of Valsalva and the corresponding aortic annulus.

Anomalous origin of the left main coronary artery from the right coronary sinus of Valsalva

Anomalous origin of the left main coronary artery from the right coronary sinus of Valsalva

P298 TRANS–AXILLARY ACCESS AS AN ALTERNATIVE ROUTE IN TRANSCATHETER AORTIC VALVE IMPLANTATION

Abstract Background Transcatheter aortic valve replacement (TAVR) is the main procedure for treating severe aortic stenosis in patients considered at high surgical risk. Generally, this procedure is performed through percutaneous femoral arterial access. The presence of anatomical variants or peripheral atherosclerotic pathology sometimes necessitates the use of alternative vascular accesses, including access through the axillary artery. Data from a meta–analysis involving 1793 patients who underwent TAVR through trans axillary or transapical access showed a statistically significant reduction in 30–day mortality in the former group. We wait for future randomized trials to confirm the consistency of these data. Clinical case 71–year–old man, smoker, hypertensive and dyslipidaemic. In 2018, he underwent bilateral aorta–iliac–femoral bypass surgery for severe lower limb arteriopathy. Due to the onset of angina and dyspnea at rest, he went to the ER where a diagnosis of NSTEMI was made. On echocardiogram, there was evidence of severe high–gradient aortic stenosis while coronary angiography showed 80% RCA stenosis in the middle tract. Because of the high surgical risk (EUROSCORE II: 12%) and the evidence of bilateral femoral artery occlusion on CT–angiography, the Heart Team concluded to perform TAVR through percutaneous left trans–axillary access with concomitant percutaneous coronary revascularization. Obtained the backup access on the left radial artery, PTCA+DES was performed on RCA through the right radial access with subsequent placement of a pigtail catheter in the non–coronary sinus of Valsalva. Once the temporary pacemaker had been placed through the right femoral vein, an angio–guided puncture of the left axillary artery was performed with placement of the 14 Fr introducer for implantation of the Medtronic Evolut R 26 mm aortic biological prosthesis. Post–procedure ultrasound examination showed a residual mean aortic valve gradient of 17 mmHg with evidence of a small periprosthetic leak. Seven days after the procedure, the patient was discharged, asymptomatic and in good hemodynamic compensation without vascular complications. Conclusions Trans–axillary arterial access should be considered a viable alternative to transfemoral access for the performance of TAVR.

A case of successful radiofrequency ablation of ectopic ventricular activity with para-Hisian origin by access from the right coronary sinus of Valsalva

A clinical case of successful radiofrequency ablation of ventricular tachycardia with para-Hisian localization of the substrate by access from the right coronary sinus of Valsalva is presented.

Challenges in primary PCI: congenital anomalous origin of the left main coronary artery from the right coronary sinus of Valsalva

Challenges in primary PCI: congenital anomalous origin of the left main coronary artery from the right coronary sinus of Valsalva

Surgical Repair of Unruptured Pseudoaneurysm of Sinus of Valsalva in Aortic Stenosis

Isolated pseudoaneurysm of a sinus of Valsalva is an uncommon sequelae of infective endocarditis. It is very uncommon in native aortic valve stenosis as compared to aortic regurgitation. We present a case of a 46 year old gentleman with a severely stenotic aortic valve with infective endocarditis, and a pseudoaneurysm of the non coronary sinus of Valsalva. The pseudoaneurysm was repaired with a prosthetic patch and the aortic valve was replaced by a mechanical prosthesis. Transthoracic echocardiography and computed tomography aortogram are an ideal diagnostic tools in suspected cases. Surgery can be curative with excellent results.

Prevalence and ablation of different anatomic locations of atrial tachicardias in the electrophysiology lab of a single large center

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Focal atrial tachycardias (ATs) can arise from several different anatomic regions both in the right atrium (RA) and left atrium (LA). The prevalence of focal atrial tachycardia is not well known. A European study of young males applying for pilot licenses demonstrated that 0.34% had asymptomatic atrial tachycardia and 0.46% had symptomatic atrial tachycardia1. It is well-recognized that these foci do not occur randomly throughout the atria but tend to cluster at characteristic anatomic locations. However, the distribution of these sites in the total amount of ATs is not well recognized. Purpose The objective of this study was to determine the prevalence of different anatomic locations of ATs in the electrophysiology lab of a single large center (300 ablations per year) and to verify the site of ablation. Methods We collected 150 consecutive patients submitted to catheter ablation of ATs between January 2010 to December 2020. Anatomic localization of the atrial focus was performed during tachicardia by analysis of endocardial activation sequence. Results The distribution of the different anatomic locations is rappresented in the figure. In 134 patients (89%) ATs were localized in the RA. In the RA, these foci mainly occured along the crista terminalis (32%), the perinodal region (22,6%), the anterior right sided septum, near the foramen ovale (9,3%), the posterior right-sided septum (8%), the ostium of the coronary sinus (5,3%), the tricuspid annulus (5,3%), the superior vena cava (4,6%), the infero-lateral wall (2,5%), the right atrial appendage (0,6%) and the cavotricuspid histhmus (0,6%). In the LA (11%), foci occur predominantly at the pulmonary vein ostia (5,2%) and less commonly at the mitral annulus (2,5%), the left sided septum (0,6%), the appendage ridge (0,6%), the roof (0,6%) and the anterior wall (0,6%). For each location of AT, the ablation was performed at the earliest activation site, but about the perinodal ATs, the ablation was performed at the non coronary sinus of Valsalva of the aortic root, regardless the earliest activation site, for avoiding to create damages to the atrio-ventricular (AV) conduction system. Conclusions ATs mainly arise from the RA. Crista terminalis is the most common site but the perinodal region is the second more frequent site. The ablation of ATs from the perinodal region is challenging for the risk of damages to the AV conduction system. The relatively low prevalence of ATs arising from the pulmonary veins could be explained for the likely degeneration of these ATs in atrial fibrillation. Abstract Figure.

Repair of Ruptured Sinus of Valsalva Aneurysm: Rare Cause of Acute Onset Congestive Heart Failure in Down’s Syndrome

A 20-year-old boy with Down´s syndrome presented to the emergency department with new onset acute heart failure. Right side chest effusion and cardiomegaly was observed on chest x-ray. A mobile aneurysmal sac protruding into the right atrium was detected and a ruptured aneurysm of the right coronary sinus of Valsalva was observed in transthoracic echocardiogram. Cardiac angiography catheterization confirmed the diagnosis. Surgical repair consisting of aneurysm resection and defect closure was performed shortly after with pericardium reinforced suture through the right atrium. The patient was discharged uneventfully.

A rare case of unruptured extracardiac multiple sinus of Valsalva aneurysms originating from the orifices with partial aortic wall defects

BackgroundSinus of Valsalva aneurysm (SVA) is relatively rare and commonly reported as a congenital anomaly. It is usually found in a single Valsalva sinus protruding into another cardiac chamber and is termed as intracardiac SVA. The aneurysm usually originates from the Valsalva sinus itself, and an orifice of the aneurysm is observed surrounded by the aortic wall. Thus, extracardiac multiple SVAs originating from the orifices with partial aortic wall defects are extremely rare. We report a very rare case of unruptured extracardiac SVAs in both left and right coronary sinuses originating from the aortic annulus.Case presentationA 76-year-old Japanese male was diagnosed with enlarged Valsalva sinuses by transthoracic echocardiography during follow-up for peripheral artery disease. Five years after careful observation, gradual SVA enlargement and moderate aortic insufficiency were observed. He underwent modified Bentall’s procedure, with an uneventful postoperative course. Intraoperatively, SVAs were found in the left lateral half of the left and right coronary sinuses of Valsalva on both sides of the commissure between the left and right coronary cusps. Aortic walls were missing at the SVA floor adjacent to the aortic annulus. Pathological examination revealed only mild atherosclerotic changes of the aortic wall near the SVAs. The cause was estimated as either focal degeneration of the sinuses of Valsalva just above the aortic annulus or congenital anomaly, or combination of both of them.ConclusionsWe report on the case of unruptured extracardiac multiple SVAs missing aortic orifice just above the annulus. No similar case presentation was found in the literature. In this paper, we present details of operative findings and procedures, which will aid in procedure selection.

A case report of pseudoaneurysm of left sinus of Valsalva invaded into the left ventricle with severe aortic regurgitation

BackgroundThe pseudoaneurysms of sinus of Valsalva is an uncommon and serious complication of an infection, trauma, or after cardiac surgery or procedure. Pseudoaneurysms of sinus of Valsalva from left is rare. We describe a case of pseudoaneurysm of the left coronary sinus of Valsalva invaded into the left ventricle (LV) diagnosed by transthoracic echocardiography (TTE), transesophageal ecoccardiography (TEE), and multiple detector computed tomography (MDCT).Case presentationA 44-year-old male patient had New York Heart Association (NYHA) class II / III dyspnea during 4 months. He underwent surgery including aortic valve replacement using mechanical prosthesis, and he was discharged well without significant complications on follow – up TTE and chest computed tomography (CT) post-operative 7 days.ConclusionsWe report this rare case in which a ruptured pseudoaneurysm of sinus of Valsalva into LV with severe AR due to perforation of LCC was successfully-treated.

Quadriostial Origin of 4 Coronary Arteries From the Right Coronary Sinus of Valsalva: Rare Anomaly

A 56-year-old hypertensive woman presented with symptoms of typical chest pain with onset 24 h before. Electrocardiography showed inferior wall myocardial infarction. Echocardiography revealed hypokinesia of inferior wall with mild mitral regurgitation (ejection fraction 48%). Coronary angiography

Thrombus in the Right Coronary Sinus of Valsalva Originating From the Left Atrial Appendage Causing Embolic Inferior Wall Myocardial Infarction.

Acute myocardial infarction (MI) is commonly a result of coronary atherosclerotic plaque rupture and superimposed thrombus formation. Nevertheless, uncommon causes of MI including embolism from aortic root and ascending aorta mural thrombi must be considered when coronary atherosclerotic disease is not evident. We report a case of a 84-year-old woman who presented with an inferior ST-segment elevation MI. Initial attempts to engage the right coronary artery (RCA) were unsuccessful. Aortic angiography revealed evidence of the left coronary artery ostium with absence of the right coronary ostium or RCA. Probing with a coronary wire where the RCA ostium was presumed to be located yielded resolution of the ST-segment elevation. The RCA was then easily engaged using a guide catheter, and angiographic evaluation showed a smooth vessel with no evidence of coronary artery disease except for abrupt termination of the distal PL2 branch. Contrast-enhanced computed tomography revealed an aortic root thrombus extending into the right coronary sinus of Valsalva and a thrombus in the left atrial appendage. The case reveals RCA embolism from an aortic root thrombus likely originating from the left trial appendage. A conservative approach to treatment with anticoagulation was pursued that resulted in full recovery. A review of the literature revealed that the etiology of aortic root thrombi is proposed to be multifactorial. Prospective randomized studies are needed to demonstrate the best treatment approach, although this appears to be impracticable given the rarity of the disease.

Acute Myocardial Infarction as the Initial Manifestation of Delayed Bioprosthesis Thrombosis After Transcatheter Aortic Valve Replacement

Bioprosthesis thrombosis after transcatheter aortic valve replacement (TAVR) raised concerns about further clinical events. We report the case of a patient who suffered acute myocardial infarction (AMI) after TAVR for 3 years. Thrombosis was confirmed in the right coronary sinus of Valsalva by transthoracic echocardiography. Coronary angiography demonstrated the ostium of the right coronary artery was occluded. As an attempt to perform percutaneous coronary intervention (PCI) was unsuccessful, long-term therapeutic anticoagulation with warfarin was undertaken. Within 2 weeks, symptoms were relieved, and the right coronary ostium thrombus disappeared on computed tomography (CT) angiography. This case highlights the AMI as initial manifestation of delayed bioprosthesis thrombosis and the importance of anticoagulation against the bioprosthesis thrombosis. Meanwhile, the difficulty of PCI after TAVR is not only the stent frame of bioprosthesis, but also the location of the thrombosis.

Right coronary artery perforation extending to the coronary sinus of Valsalva during percutaneous intervention successfully sealed with polytetrafluoroethylene-covered stent: a case report

BackgroundRight coronary artery perforation extending to the sinus of Valsalva is a rare and potentially fatal complication of percutaneous coronary intervention. There are no definite guidelines on the management strategies for such complications. Treatment modality depends on the patient’s haemodynamic stability and the extent of aortic involvement. Polytetrafluoroethylene-covered stents have emerged as a revolutionary strategy, enabling efficient endovascular repair of the entry port of such dissections, particularly the coronary ostia, and obviating the need for high-risk emergent surgical intervention.Case presentationA 60 year old Bangladeshi gentleman underwent a coronary angiogram following a prior inferior ST elevation myocardial infarction (MI), 1 month previously. Coronary angiography done via right radial approach using 5 FR TIG catheter showed diffuse mid RCA disease with maximum 90% stenosis. Angioplasty of the RCA was planned. The RCA was cannulated with a 6-French JR 3.5 guiding catheter (USA). The lesion was crossed by a 0.014 inch guide wire and stented with a 2.75 × 38 mm novolimus-eluting DESyne stent, after predilatation. Immediately after stenting, a Type II perforation was observed in the ostial RCA, which progressed into the right coronary sinus of Valsalva. As the patient was haemodynamically stable with no ischaemia on ECG, we attempted to seal the ostial RCA with bare metal stents. Two successive bare metal stents failed to seal the aorto-coronary dissection. Ultimately, a 3.0 × 19 mm polytetrafluoroethylene-covered stent was deployed to seal the entry port in the ostial RCA, yielding a satisfactory angiographic result with only minimal contrast staining limited to the right sinus of Valsalva. The patient was closely monitored and discharged on dual antiplatelet therapy comprising of aspirin and prasugrel. He remained asymptomatic and with follow up echocardiograms showing no pericardial effusion nor extension of the dissection.ConclusionsThe polytetrafluoroethylene-covered stent provides a safe and effective means of sealing iatrogenic aorto-coronary dissections complicated by Ellis type II or II perforations, thus avoiding emergency surgery. However, as they are associated with increased incidence of stent thrombosis, an efficient and prolonged post-PCI antiplatelet regimen is recommended.

Acute Myocardial Infarction Caused by Embolism of Tadpoles Like Thrombus in the Right Coronary Sinus of Valsalva

Acute Myocardial Infarction Caused by Embolism of Tadpoles Like Thrombus in the Right Coronary Sinus of Valsalva

Anatomic Correlation of Posterior Aortic Root Enlarging Incisions.

To clarify the terms surrounding the posterior aortic root enlarging incisions and correlate them anatomically. This is a human cadaveric heart study in which measurements were taken along the path of the named incisions in 42 normal and congenitally malformed hearts using calipers. Our results indicate that there is a variable overlap of the left atrial wall with the anterior mitral leaflet and the aorta and that in individual cases it may not be possible to accurately predict the possibility of enlarging the root without opening the left atrium, though some papers suggest otherwise. Names associated with incisions are best avoided. Rather they should be described anatomically. Incision between the noncoronary sinus of Valsalva and left coronary sinus of Valsalva may be the safest approach to enlarging the root.

Anomalous origin of the left coronary artery

Coronary artery anomalies are a frequent finding in the general population and often result in sudden death. Therefore, rapid diagnosis and surgical correction are essential. Although coronary arteriography ultimately is necessary to determine the exact nature of the anomaly, two-dimensional echocardiography and radionuclide tests may provide valuable information in the initial workup of patients with chest pain, as demonstrated in the case reported here. This patient, who had angina-like symptoms, was found on cardiac angiography to have an anomalous left coronary artery rising from the right coronary sinus of Valsalva. Double coronary artery bypass grafting involving the left anterior descending and circumflex marginal vessels alleviated symptoms and resulted in improved exercise tolerance. The authors discuss theories explaining the spectrum of ischemia, infarction, and sudden death and surgical alternatives that improve survival rates.

Acquired Large Calcified Unruptured Sinus of Valsalva Aneurysm

Acquired aneurysms of the sinus of Valsalva are rare. They are caused by infections such as tuberculosis, syphilis and endocarditis, as well as atherosclerosis and traumatic injury. They may be asymptomatic and incidentally discovered. We present a rare case of a large acquired calcified unruptured aneurysm of the right coronary sinus of Valsalva that was compressing the right ventricular outflow tract.

Myocardial ischemia due to a type IV dual LAD with the long LAD arising from the right sinus of valsalva: a case report and literature review.

We herein report the case of a 60-year-old man who presented with chest discomfort. Coronary angiography demonstrated that the short left anterior descending artery (LAD) arose from the left main coronary artery and the long LAD from the right coronary sinus of Valsalva, which was confirmed by 64-slice multidetector computed tomography coronary angiography. Single-photon emission computed tomography revealed a significant, almost irreversible degree of hypoperfusion in the anterior wall of the left ventricle, thus indicating that the short LAD was associated with myocardial ischemia and severe atherosclerotic lesions. Therefore, SPECT showed that the myocardium was largely necrotic, and we did not perform angioplasty for the short LAD.