Right Coronary Sinus Research Articles

An observational study of symmetrical VSD occluder for transcatheter closure of ruptured sinus of Valsalva aneurysm.

This study evaluated the immediate and 1-year postoperative outcomes of 14 patients with ruptured Valsalva aneurysmal sinus (RSVA) using symmetric ventricular septal defect (VSD) occluder for transcatheter closure (TCC). The sites of rupture were from the non-coronary sinus to the right atrium (RA) in 10 cases (71.4%), the right coronary sinus (RCS) to the RA in 3 cases (21.4%) and the RCS to the right ventricle in 1 case (7.2%). The defects (5-11 mm) were closed with a symmetrical VSD device. During the follow-up (12 months), the enlarged heart of the patients had significantly shrunk and the NYHA improved after closure. In 1 case, a moderate residual shunt was present and the patient suffered from hemolysis at 2 h after the operation, and 1 patient was transferred to surgery for aortic regurgitation 1 year after the initial treatment of RSVA. In conclusion, the TCC of RSVA with the China made symmetrical VSD occluder is safe and effective.

Intra- and interobserver reliability in measuring aortic root rotation with cardiac magnetic resonance imaging.

The rotational position of the aortic root (AoR) is of substantial clinical interest as it has been associated with severe aortic complications, such as aortic dissections. We described a cardiac magnetic resonance (CMR)-based method for measuring AoR rotation and evaluated the reliability of measurements. CMR was used for measuring AoR rotation in 50 consecutive healthy subjects. Intra- and interobserver reliability were assessed by comparing repeated measurements by the same analyst and by three independent analysts. The angles of the non-coronary sinus (NCS), right coronary sinus (RCS), and left coronary sinus (LCS) were measured relative to the interatrial septum (IAS). The angle between IAS and posterior atrial wall was measured to examine the reliability of the IAS as a key anatomical landmark. Intra- and interobserver agreement were determined using intraclass correlation coefficients (ICCs). Images of 47/50 (94%) subjects were analyzed; three were excluded due to insufficient image quality. The mean ± standard deviation (SD) AoR rotation angles of NCS, RCS, and LCS were 25.9°±12.9°, 37.5°±15.2°, and 97.0°±13.1°, respectively. For measurements of AoR rotation, both intraobserver [NCS: ICC =0.94, 95% confidence interval (CI): 0.88-0.96; RCS: ICC =0.93, 95% CI: 0.87-0.96; LCS: ICC =0.91, 95% CI: 0.84-0.95] and interobserver agreement (NCS: ICC =0.90, 95% CI: 0.84-0.94; RCS: ICC =0.86, 95% CI: 0.77-0.92; LCS: ICC =0.87, 95% CI: 0.80-0.92) were excellent. The IAS angle was 79.2°±8.9°; its intraobserver agreement was somewhat higher (ICC =0.94, 95% CI: 0.88-0.96) than the interobserver agreement (ICC =0.76, 95% CI: 0.63-0.85). The present study in healthy subjects reports a CMR-based approach for measuring AoR rotation. CMR allows to quantify AoR rotation with excellent intra- and interobserver agreement.

Incidental diagnosis of Coronary Anomaly of the Circumflex Artery with Retroaortic Course by Transthoracic Echocardiography in young athlete

The morphology of human coronary anatomy is fascinating because it is variable. When the morphology deviates from typical anatomy, it is considered anomalous, but this occurs in less than 1% of the population. The left circumflex anomaly is one of the most common congenital anomalies of the coronary arteries, whether it originates from the right coronary sinus (RCS), ergo the right sinus of Valsalva (RSV), or from the proximal right coronary artery and cusp. In this report, the author describes the original case of a 22-year-old healthy male and fit athlete with an anomalous course and origin of the LCX, diagnosed on TTE by the typical RAC during sports pre-participation screening.

Dual left anterior descending coronary artery and anomalous origin of left circumflex artery: a novel coronary anomaly revealed by CCTA.

In the rare coronary anomaly of Dual LAD, two segments of the vessel reside within the anterior interventricular sulcus. In our case, the short LAD originated from the Left Coronary Sinus (LCS), while the long LAD emerged from the Right Coronary Sinus (RCS). The LCx arose from the RCS, and the RCA displayed typical features. This anomaly was deemed incidental, prompting routine follow-up. It underscores the significance of integrating CCTA for a thorough assessment, offering crucial insights for patient management.

Frequency of Coronary Artery Anomalies Undergoing Coronary Interventions Patients at Tertiary Hospital

Aims: This study aims to identify the frequency of Coronary Artery Anomalies (CAA) in coronary intervention receiving patients at tertiary care hospital.
 Sample: To obtain the sample size of the study i.e., 228 were selected at a Confidence level of 95%.
 Study Design: Cross-sectional study.
 Place and Duration of Study: This Descriptive cross-sectional study was conducted at Tertiary care hospital - National Institute of Cardiovascular Disease, Sindh-Karachi. Six months after the approval from IRB-NICVD (April 2018 – October 2018).
 Methodology: Nonprobability consecutive sampling was used to collect the study data. All Patients of either gender from age 18 to 60 years of age undergoing Primary Coronary Intervention (PCI)/ coronary artery angiography because of substernal chest pain were included.
 Results: Total 228 sample population was enrolled in the study, among which 88 (38.6%) were females and 140 (61.4%) were males. CAA was found in the coronary arteries of patients with abnormal aortic valves with a frequency of 1.3 percent. The most often occurring anomaly in our analysis is the separation of the origins of Left Anterior Descending Artery (LAD) and Left Circumflex Artery (LCx) from the Left Coronary Artery (LCA). The Circumflex Artery resulting from Right Coronary Sinus (RCS)/ Right Coronary Artery (RCA) was the second most often seen anomaly in our analysis, accounting for 22.78 percent of all anomalies. The RCA caused by LCS was the next abnormality, with a 7.59 percent frequency. In three cases, the left major coronary artery was derived from RCS, accounting for 3.8 percent of abnormalities.
 Conclusion: Among patients receiving diagnostic coronary angiography, we discovered a 0.9 percent incidence of coronary artery abnormalities. In our research, the prevalence of coronary artery abnormalities was 7% among patients who had coronary procedures. The drawback of our research is that we only included individuals who had had coronary angiograms rather than a random sample of the different cardiac tertiary care hospitals.

Commentary: Sometimes the best solution is to simplify

Luo and colleagues1 describe their modified 2-patch technique for the repair of supravalvular aortic stenosis. In their modification, the authors perform a transverse aortic incision above the sinotubular junction and then make 2 vertical incisions into the non- and right-coronary sinuses. These 2 incisions are extended superiorly into the ascending aorta, forming a final H-like incision (hence the name H-repair). Following that, 2 separate rectangle-shaped pericardial patches are utilized to reconstruct the non- and right-coronary sinuses, with the sizes of the distal patches adjusted to achieve normal sinotubular junction diameter.

H-repair in supravalvular aortic stenosis.

H-repair in supravalvular aortic stenosis.

Ruptured sinus of Valsalva aneurysms - our surgical experience of 7 years.

IntroductionAneurysms of sinuses of Valsalva are rare aortic anomalies having an incidence of 1.4–4.94% in the Asian population. Spontaneous rupture is the most common complication and ruptured aneurysms usually present with congestive cardiac failure.AimOur study was aimed at evaluating the clinical profile of patients with ruptured sinus of Valsalva aneurysms (RSOVA) and their distribution, the surgical management and post-operative course.Material and methodsWe retrospectively identified 21 patients who presented to us with RSOVA over a period of 7 years and underwent surgery for the same.ResultsRSOVA was more common in young males. Most cases involved the right coronary sinus (RCS) followed by the non-coronary sinus (NCS). The site of rupture was mostly the right ventricular outflow tract or the right atrium. All patients had a relatively asymptomatic post-operative course in the ward. On follow-up, most of the patients were symptom free.ConclusionsSurgery on cardiopulmonary bypass with moderate hypothermia with excision of windsock deformity and patching of the rupture site is a safe method of treating ruptured sinus of Valsalva aneurysms. Patients need to be followed up regularly to monitor for the development of aortic regurgitation.

Percutaneous Coronary Intervention in an Octogenarian With Anomalous Origin Arising From Right Sinus: A Rare Case Report

Anomalous coronary artery origins are not common in routine clinical practice. The incidence of coronary anomalies in patients undergoing coronary angiography is less than 1%. The greatest challenges faced in the management are delays in identification and difficulty engaging the anomalous coronary artery. Operator experience in promptly identifying the anomaly and selection of the appropriate catheter is critical for successful intervention. We are presenting a case of acute inferior and posterior wall myocardial infarction (MI) with an anomalous origin of the left circumflex artery from the right coronary sinus. Learning objective is that percutaneous coronary intervention (PCI) in an anomalous left circumflex can be technically difficult because selective cannulation of the vessel may not be easy. An anomalous left circumflex artery has a rare presentation of ST-elevation myocardial infarction (STEMI). Complicated STEMI with cardiogenic shock is not commonly seen in anomalous coronary artery origin from the right sinus. Percutaneous intervention in patients with STEMI with an anomalous left circumflex artery has a high risk and is technically challenging. J Med Cases. 2020;11(2):41-43 doi: https://doi.org/10.14740/jmc3429

P724 The mysteries of sinus of Valsalva

Abstract Sinus of Valsalva aneurysms are a rare pathology that can be clinically silent during years and/or become suddenly symptomatic. We described 3 cases with different clinical presentation, complications and surgical treatment. A 26-year-old male, competitive cyclist was admitted with a 1.5 month history of fatigue, palpitations, and nocturnal cough and sweating. At physical examination he was apyretic, blood pressure 157/49mmHg and radial pulse 96 bpm; jugular vein engorgement and continuous heart murmur, were noticed. Blood samples only revealed a mild raised BNP. EKG showed sinus tachycardia and right intraventricular conduction delay and the transthoracic echocardiography (TTE) revealed high velocity systolic-diastolic shunt (image) between a non-dilated right coronary sinus (RCS) and the right atrium (RA); moderate left ventricle dilation, severe right atrium and mild right ventricle enlargement with mild pulmonary hypertension and normal biventricular systolic function. He was referred to angioCT that showed a large communication between a non-dilated RCS and RA with signs of right ventricular overload. He was submitted to surgery, where ruptured aneurysm sac was found. Fistula closure, aneurysm sac suture and tricuspid annuloplasty were performed. A 45-year-old male asymptomatic, with no relevant medical background went to a Cardiology consultation after detection of a holossistolic murmur in the physical exam. EKG showed sinus rhythm arrhythmia with a nonspecific intraventricular conduction delay and the TTE revealed a communication between a dilated noncoronary sinus (NCS) and RA; the biventricular systolic function was normal. He was referred to angioCT which confirmed the diagnosis. He was submitted to surgery where an exeresis and closure of the fistula was performed. A 38-year-old male with no relevant medical background was admitted to emergence room for an intermittent anterior thoracic pain radiating to the neck (2 days of evolution). The EKG showed sinus tachycardia, incomplete right bundle branch block and the high-sensitivity troponin assays were negative. The TTE revealed severe sinus of Valsalva aneurysm, particularly of the NCS with mild aortic regurgitation. The patient performed transesophageal echocardiography and angioCT which excluded an acute aortic syndrome. He was oriented to surgery where a contained rupture of the RCS and a non-visualization of the ostium right coronary artery were detected, suggesting an intimal dissection. The patient was submitted to Bentall procedure and a bypass with internal mammary artery to right coronary artery. In spite of the unclear etiology, all the cases had a good clinical and echocardiographic evolution at follow-up. The difficulty in making a timely diagnosis is related to the variability of clinical presentation and the need of high clinical suspicion. Echocardiography and angioTC have demonstrated its value, in providing a prompt diagnosis and appropriate management guidance. Abstract P724 Figure. Ruptured aneurysm sac and fistula

Asymmetric Dynamics of the Native Aortic Annulus Evaluated by Force Transducer and Sonomicrometry in a Porcine Model

PurposeWith new repair techniques of the aortic root and valve emerging, a detailed understanding of the dynamics of the aortic annulus and valve is required for optimal results. The objective of this study was to characterize geometrical changes and force distribution of the native porcine aortic annulus throughout the cardiac cycle.MethodsMeasurements were performed in an acute 80 kg porcine model (n = 7) using sonomicrometry crystals in the aortic annulus for evaluation of geometry and dynamics, annular force transducer evaluating force distribution, and pressure measurements and echocardiography evaluating valve performance.ResultsOverall, segmental force distribution and geometrical changes differed between different segments of the aortic annulus. The highest force development was found at the left/right interleaflet triangle (2.87 ± 2.1 N) and the largest segmental expansion was observed at the right-coronary and left-coronary sinus. The aortic annulus changed configuration throughout the cardiac cycle and became more oval in systole.ConclusionsThis study is the first to describe detailed segmental dynamics and force distribution of the native aortic annulus in a porcine model in vivo. The heterogenous behavior of the aortic annulus suggests that different segments demand different support for repair of the aortic root and valve.

Prevalence and Spectrum of Coronary Anomalies Detected on Coronary Computed Tomography Angiography: A single centre experience in Oman.

ObjectivesCoronary artery anomalies (CAAs) are uncommon congenital abnormalities with a prevalence ranging from 0.2–2%. CAAs can be asymptomatic or less commonly present with life-threatening symptoms. This study aimed to investigate the prevalence and spectrum of CAAs in patients who underwent coronary computed tomography angiography (CCTA) in Oman.MethodsThis retrospective study was conducted at the National Heart Centre, Muscat, Oman between September 2012 and August 2018. All consecutive patients who had undergone CCTA were included.ResultsA total of 4,445 patients were included in this study. Of these, 59 patients (1.3%) were diagnosed with CAAs with a mean age of 52.6 years (range: 12–80 years) and an equal gender distribution. Among the patients with CAAs, the majority (69.5%) had anomalous origins from the opposite or non-coronary sinus. Right coronary artery arising from the left coronary sinus was the most common type (33.9%). Fewer patients (18.6%) had left circumflex arising from the right coronary sinus (RCS). Seven patients (11.9%) had left main arising from the RCS. Other CAAs were in the dual left anterior descending artery (8.5%), high coronary artery take-off (6.8%), single coronary ostia (6.8%) and coronary artery fistula (6.8%).ConclusionThe prevalence of CAAs was 1.3% which is similar to the literature.

Imaging by multislice CT of a large aortico-left ventricular tunnel mimicking as ventricular septal defect

Aortico-left ventricular tunnel (ALVT) is a rare congenital cardiac anomaly that presents as paravalvular communication connecting the ascending aorta above the sinotubular junction and the left ventricle. In majority of cases the aortic orifice lies above the right coronary sinus (RCS). Clinically, most such cases present along with congestive heart failure. ALVT is associated with many cardiac anomalies like bicuspid aortic valve, patent ductus arteriosus and ventricular septal defect (VSD). Here we describe a case of ALVT that was misinterpreted as VSD initially on echocardiography. This report highlights the significance of multislice CT angiography (CTA) in accurate preoperative diagnosis of this rare entity.

ANGIOGRAPHIC STUDY OF ANATOMICAL VARIATIONS OF CORONARY ARTERIES BY USING DIAGNOSTIC CATHETER

The coronary arteries may present several anomalies, in terms of both number and position. New image-based diagnostic techniques have led to greater reliability in the identification of these anomalies.Aim of the work:this work is done to study the angiographic pattern of normal coronary arteries variations by using the diagnostic catheter.Material and Methods: Any patient enlisted for angiography in catheterization lab in Zagazig University Hospital was enrolled in this study.Results: Data of 4246 patients who underwent coronary angiography were analysed. 115 patients who had anomalous of coronary arteries were entered into final data analysis.The following data could be concluded: The overall incidence of primary congenital coronary anomalies was 2.7% (115 out of 4,246 patients) in our angiographic population, of whom 86 were males (74.7%) and 29 were females (25.3%). The mean age was (45.95 ± 11.65) years. Anomalous LCX was the most common coronary anomaly being present in 35 patients (0.82%) . The second most common anomaly was myocardial bridge and it was present in 31 patients (0.73%). Anomalous RCA was present in eighteen patients (15.65%). Left main coronary artery was absent in two cases (1.7%) and it has anomalous origin from right coronary sinus (RCS) in another two cases (1.7%). On the other hand, anomalous LAD was present in 8 patients (6.95 %). Coronary aneurysms were observed in 10 cases (7.82%). On the other hand, coronary fistulas were diagnosed in nine cases (8.7%). The incidence of coronary anomalies among cases with coronary artery detected disease was 72.2% (83 cases) while this incidence among those without angiographically detected coronary artery disease was 27.8% (32 cases). Hence, the frequency of coronary artery anomaly was significantly higher among patients with CAD than those without CAD ( P < 0.0001). Conclusion:Coronary artery anomaly is a common anomaly between the populations. It could be the only cause of chest pain without significant coronary lesion.

Coexisting ventricular septal defect affects the features of ruptured sinus of Valsalva aneurysms.

Objectives:To determine the correlation exists between ventricular septal defect (VSD) and ruptured sinus of Valsalva aneurysm (RSVA).Methods:Between September 2003 and April 2014, 80 RSVA patients underwent surgical repair. These patients were retrospectively divided into two groups: the VSD group (38 cases) and the non-VSD group (42 cases).Results:Rupture points of SVA originated more frequently in the right coronary sinus (RCS) of patients in the VSD group than those in the non-VSD group (p=0.002). In the VSD group, more than 92.1% tended to rupture into the right ventricular outflow tract. The rupture points are diverse in the non-VSD group. A significant difference was found in rupture points of RSVA between the two groups (p<0.001). Patients in the VSD group presented with aortic valve disease more often than those in the non-VSD group (p<0.001). A total of 67 patients were repaired with a patch at the opening of RSVA; of those, all patients in VSD group and 29 patients in non-VSD group were repaired with a patch. Nine patients in non-VSD group received transcatheter closure of RSVA.Conclusion:The presence or absence of VSD affects the rupture points of SVA, aortic valve disease involved, and therapeutic schedule. Ruptured sinus of Valsalva aneurysm type should be clinically modified on the basis of presence or absence of VSD.

Safety and Feasibility of Transcatheter Interruption of Ruptured Sinus of Valsalva Aneurysm Using the Cocoon Duct Occluder: Immediate Results and Mid-Term Follow-Up.

BackgroundLimited data are available regarding safety and feasibility of transcatheter interruption of ruptured sinus of Valsalva aneurysm (RSOVA) using the Cocoon duct occluder (CDO) with immediate and mid-term follow-up result.MethodsTranscatheter closure (TCC) was successfully done among eight patients, whereas five cases, not amenable to TCC, were referred for surgical correction among 13 consecutive patients of RSOVA at LPS Institute of Cardiology, Kanpur between January 2010 and March 2015.ResultsTheir mean age was 26.1 ± 6.9 years. Sites of rupture were from right coronary sinus (RCS) to right atrium (RA) in one (12.5%), right ventricle in one (12.5%), and non-coronary sinus to RA in six patients (75%). The defects (9 - 17 mm) were closed by CDO (12/10 - 20/18 mm) with 100% procedural success. During follow-up (9 - 26 months), there was no residual shunt, progression of AR, infective endocarditis or device embolization.ConclusionTCC of RSOVA appears to be a safe and feasible alternative to surgical therapy, with high technical success and excellent mid-term follow-up.

Prevalence of the Anomalous Aortic Origin of a Left Coronary Artery from the Right Coronary Sinus and Posterior Course: detection by Transthoracic Echocardiography in an Unselected Ambulatory Population

&lt;p&gt;&lt;span style="font-size: medium;"&gt;&lt;span style="font-family: Times New Roman;"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Transthoracic echocardiography (TTE) may detect the origin and/or abnormal course of coronary epicardial vessels. We describe a novel TTE pattern specific for the anomalous origin of a left coronary vessel from the right coronary sinus and a posterior course and its prevalence in an unselected population of ambulatory patients.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;span style="font-size: medium;"&gt;&lt;span style="font-family: Times New Roman;"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We prospectively studied 3692 consecutive patients who performed a routine TTE. In these subjects we looked for an abnormal finding that we found associated with the anomalous aortic origin of a coronary artery. Computed Tomography of the Coronary Arteries (CTCA) was performed in each suspected case.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;span style="font-size: medium;"&gt;&lt;span style="font-family: Times New Roman;"&gt;&lt;strong&gt;Results:&lt;/strong&gt; We found a TTE aspect suggestive for a coronary anomaly and a retroaortic course in 16 subjects out of the 3298 studied (0,48%). CTCA invariably confirmed the presence of the anomaly. In 15 out of the 16 patients the left coronary vessel originating from the right coronary sinus (RCS) was the left circumflex artery (LCX). In the remaining patient the anomalous vessel was the left main coronary artery . &lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;span style="font-size: medium;"&gt;&lt;span style="font-family: Times New Roman;"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We found a TTE sign specific for a particular kind of coronary anomaly. By using TTE it is possible to detect the retroaortic course of an anomalous left coronary vessel originating from the RCS. This pattern was found to be rare but pathognomonic for this specific kind of congenital anomaly. The ability to detect this specific kind of coronary anomaly by TEE may be relevant to the patient in some cases thus representing useful clinical information.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

Application of intraoperative transesophageal echocardiography for occluding the rupture of aortic sinus aneurysm by cardiac interventional therapy via mini-thoracotomy

Objective To assess the application of intraoperative transesophageal echocardiography for occluding the rupture of aortic sinus aneurysm(RASA) by cardiac interventional therapy via mini thoracotomy. Methods After anesthesia transesophageal echocardiography (TEE) was performed in patients with RASA to confirm or correct primary diagnosis from transthoracic echocardiography(TTE) and to predict the operative effect. During the operation the guide wire and Sheath pipe were accurately guided into rupture mouth of aortic sinus aneurysm by TEE. After the operation, the position of closure and the function of aortic valve need to check carefully. Results Collection of 38 patients with aortic sinus aneurysm rupture, 20 patients who can be received interventional therapy were select by TEE. Sixteen patients accepted interventional treatment successfully, including 8 cases with non-coronary sinus tumor to break into the right atrium, 5 cases with non-coronary sinus tumor to break into the right ventricle, and 3 cases with right coronary sinus tumor to break into the right ventricular outflow tract (3 cases). The patients who received intervention treatment successfully had stable vital signs, and no obvious changes of heart cavity structure and cardiac function in normal. Postoperative multiple reexamination, all patients showed the normal closure position, aortic valve opening and closing movement. And no stenosis and reflux signal, no residual shunt was detected. Conclusions TEE can confirm or correct primary diagnosis of TTE before the operation and guide the surgery operator to place the closure correctly during the operation and evaluate the effect of the treatment after the operation. Key words: Echocardiography, transesophageal; Aortic sinus aneurysm; Aneurysm, ruptured

Methodology study for the anatomic structure of aortic root using three-dimensional transesophageal echocardiography

Objective To establish a quantitative analysis method for the anatomic structure of aortic root by real-time three-dimensional transesophageal echocardiography, and to explore the reliability and repeatability of this method. Methods Ninety five adult patients underwent RT-3DTEE were included in this study.Full-volume 3D images of aortic root were acquired and analyzed offline with QLab-3DQ (iE33, Philips). The three mutually perpendicular plane were determined. Results 1) Aortic root: At the end of diastole, the diameter and area of coronary artery sinus bottoms level was 1.84 cm and 3.45 cm2; the diameter and area of top commissural level was 2.97 cm and 7.77 cm2; the diameter and area of sino-tubular junction level was 2.72 cm and 5.44 cm2. 2) Aortic sinus: right coronary sinus was widest, left coronary sinus was the most stenosis(P 0.50). The measurement of each parameter, which analysis among different angles showed that 0° region were more accurate than others. Conclusions 3D quantitative analysis to aortic root can be established by full-volume RT-3DTEE images and has better reliability and repeatability. Key words: Echocardiography, transesophageal; Echocardiography, real-time three-dimensional; Aortic root; Methodology; Quantitative analysis

Percutaneous Transcatheter Closure of Ruptured Sinus of Valsalva Aneurysm: Immediate Result and Long-Term Follow-Up.

There is scarcity of data on closure and long-term follow-up of percutaneous treatment of ruptured sinus of Valsalva aneurysm (RSOVA). In this article, we present our experience in percutaneous closure of this defect. Between December 2009 and July 2014, 11 cases of RSOVA were referred to our hospital. Eight of the 11 cases (72.7%) were considered for percutaneous closure. Seven of the eight (87.5%) patients underwent successful percutaneous closure. There were four females and three males in the age group of 16 to 48 years (mean 24.7 ± 6.1 years). Associated defects were bicuspid aortic valve in one patient, mild preexisting aortic regurgitation in two patients, and healed infective endocarditis in one patient. Echocardiography revealed RSOVA from right coronary sinus (RCS) to right atrium (RA) in one patient (14.3%), RCS to right ventricular outflow in three patients (42.8%), and noncoronary sinus ruptured into RA in three patients (42.8%). All patients were symptomatic in New York Heart Association (NYHA) class II to IV. The defect size ranged from 7 to 10 mm (mean 8.4 ± 1.3 mm). The defects were closed from the venous side with device selection 2 to 4 mm higher than the defect size under fluoroscopy and transesophageal echocardiography guidance. Technical success was 87.5%. The mean device size was 12.0 ± 1.6 mm/10.0 ± 1.6 mm. Six out of seven patients (85.7%) had complete disappearance of shunt before discharge. During 1 to 55 months follow-up, all patients were in NYHA class I. There was no residual shunt, progression of AR or new AR, infective endocarditis or device embolization. Percutaneous closure of RSOVA appears to be a safe alternative to surgical therapy, with high technical success and excellent long-term outcome.