Ruptured Sinus Of Valsalva Aneurysm Research Articles

Abstract 12143: Hearing is Believing: A Case of a Ruptured Sinus of Valsalva Aneurysm

A 36-year-old previously active and healthy male was referred to our Adult Congenital Heart Disease clinic with worsening exertional dyspnea and intermittent palpitations over the past 6 months. He had recently been diagnosed with a membranous ventricular septal defect (VSD) and membranous septal aneurysm at another hospital, although images were not available for review.On physical exam, a continuous cardiac murmur was noted which prompted reconsideration of the diagnosis, with highest suspicion of ruptured sinus of Valsalva aneurysm (SVA). An urgent cardiac CT was obtained, which showed a large, mobile right SVA protruding into and partially obstructing the right ventricular outflow tract (RVOT), with pulmonic regurgitation and dynamic closure of a supracristal VSD (Figure 1A). A margin of the SVA was ill-defined and suspicious for rupture, although no definite communication was seen. An expedited TTE showed findings consistent with SVA rupture (Figure 1B), and he was admitted for surgery soon thereafter. Intra-operatively (Figure 1C), SVA rupture into the RVOT was confirmed by direct inspection; the SVA tissue was resected, the defect closed with a fresh autologous pericardial patch, and the VSD was closed with pledgeted sutures. Post-operatively, there was no leakage around the patch margin and only trace aortic regurgitation.A ruptured SVA causes continuous shunting from the aorta into an adjacent cardiac chamber and if left unrecognized, can lead to right heart failure, arrhythmia, and potentially sudden death, emphasizing the need for early identification. Echocardiography may show an aneurysmal sinus of Valsalva with a continuous (with accentuation in diastole) high-velocity, turbulent flow-jet into an adjacent cardiac chamber, and holodiastolic aortic flow reversal; a VSD is often present. Cross-sectional imaging is also important for diagnosis and surgical planning. A comprehensive physical exam is crucial to mitigate the risk of misdiagnosis.

Percutaneous closure versus surgical repair for ruptured sinus of valsalva aneurysm: A systematic review and meta-analysis.

Ruptured sinus of Valsalva aneurysm (RSVA) often has an abrupt onset, and can chest pain, acute heart failure, and even sudden death. The effectiveness of different treatment modalities remains controversial. Thus, we completed a meta-analysis to evaluate the efficiency and safety of traditional surgery vs. percutaneous closure (PC) for RSVA. We carried out a meta-analysis using PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Data, and the China Science and Technology Journal Database. The primary outcome was comparing in-hospital mortality between the two procedures, and the secondary outcome was documenting postoperative residual shunts, postoperative aortic regurgitation, and length of hospital stay in the two groups. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships between predefined surgical variables and clinical outcomes. This meta-analysis was conducted using Review Manager software (version 5.3). The final qualifying studies included 330 patients from 10 trials (123 in the percutaneous closure group, and 207 in the surgical repair group). When PC was compared to surgical repair, there were no statistically significant differences in in-hospital mortality (overall OR: 0.47, 95%CI 0.05-4.31, P = 0.50). However, percutaneous closure did significantly decrease the average length of hospital stay (OR: -2.13, 95% CI -3.05 to -1.20, P < 0.00001) when compared to surgical repair, but there were no significant between-group differences in the rates of postoperative residual shunts (overall OR: 1.54, 95%CI 0.55-4.34, P = 0.41) or postoperative aortic regurgitation (overall OR: 1.54, 95%CI 0.51-4.68, P = 0.45). PC may become a valuable alternative to surgical repair for RSVA.

Ruptured sinus of Valsalva aneurysm with dynamic aortic regurgitation.

The ruptured sinus of Valsalva aneurysm (SVA) can present with dynamic aortic regurgitation (AR). Hemodynamic changes elicited by induction of general anesthesia can lead to dynamic AR in setting of ruptured SVA. Perioperative echocardiography is critical in understanding the etiology of AR and in guiding surgical decision-making. If the aortic valve is structurally normal, AR may resolve following patch repair of the SVA rupture defect. Conventional measures of assessing AR severity are not accurate with continuous left-to-right flow across a ruptured SVA.

An Unusual Case of Ruptured Sinus of Valsalva Misdiagnosed as Acute Coronary Syndrome

Background: Ruptured sinus of Valsalva aneurysm (RSOVA) is rare and can mimic many other diseases. It may be misdiagnosed on initial evaluation. Uncorrected almost invariably, it has a rapid downhill course. We present a case which was initially misdiagnosed as acute coronary syndrome (ACS). Case Summary: A 49-year-old lady presented to a local hospital with history of chest pain. She was diagnosed with ACS based on history and electrocardiogram findings and treated conservatively. She deteriorated and developed multiorgan failure. She was transferred to our center for further management. On re-evaluation, transthoracic echocardiography showed RSOVA. She was treated with transcatheter device closure. She recovered well and was discharged in stable condition. Discussion: This case highlights the diagnostic difficulty when patients present with features of other common diseases. Right heart failure evaluation in the setting of appropriate clinical features should prompt consideration of RSOVA as a differential diagnosis. RSOVA if managed appropriately can lead to complete recovery.

Transcatheter Versus Surgical Closure of Acute Ruptured Sinus of Valsalva Aneurysms with Associated Ventricular Septal Defects.

Transcatheter ruptured sinus of valsalva aneurysm (RSOVA) closure is an alternative to surgery. When a restrictive ventricular septal defect (rVSD) coexists, there are doubts about support for an occluder and persistent left ventricular (LV) dilatation. We compared the outcomes of patients from a single centre with rVSD and RSOVA after surgery or transcatheter intervention in the past 8years in this study. Location of rVSD did not alter the approach. Compliant balloon interrogation before transcatheter closure was occasionally used to assess significance of interventricular shunt or aortic regurgitation. Procedural success and LV dimensions before and after treatment were analyzed. Seventeen patients with a mean age of 36.64 ± 12.58years were analyzed. 12/13 catheter procedures (92%) were successful, of whom eight patients had an outlet VSD. rVSD was closed with device in one patient with perimembranous rVSD, but unaddressed in others. Four patients underwent balloon interrogation. Surgery included the single patient who failed intervention. Transcatheter group had more acute symptoms and advanced functional class than surgical group, though not significant. At a median follow-up of 4.5 (1-7.5) years, the mean LV dimensions (50.3 ± 10.1mm and 50.1 ± 3.1mm, p = 0.46) were not different in the transcatheter and surgical groups. Mean end-diastolic volumes (110.5 ± 42. 1ml and 98.5 ± 37.5ml, p = 0.91) were not significantly different either. Transcatheter RSOVA closure success was not altered by rVSD despite their location underneath the aneurysms, including outlet rVSD with defect in aortoventricular junction. Persistent LV dilatation was not observed after catheter intervention even when the VSD was not closed.

Ruptured Sinus of Valsalva Aneurysm from Left Coronary Sinus with Different Causes

Objective: Analysis of three cases in which the clinical diagnosis was ruptured sinus of Valsalva aneurysm (RSVA) from left coronary sinus, combined with similar cases in the literature, to summarize the etiology of RSVA. Methods: Retrospective analysis of three cases of RSVA diagnosed in our hospital from 2009 to 2021. Their general condition, examination and treatment were analyzed, and the etiology of the sinus of Valsalva aneurysm (SVA) was summarized in relation to similar cases reported in the literature. Results: All three cases were diagnosed as RSVA from left coronary sinus with a clear etiology of congenital SVA, Behcet’s disease and infective endocarditis, respectively. They all underwent successful surgical treatment. In the literature, there were 12 cases of SVA from left coronary sinus of definite etiology, 10 of which ruptured. Conclusions: SVA from left coronary sinus is a rare disease with a complex etiology, and RSVA is one of the most serious complications of SVA. Exploring the etiology of SVA will help to prevent the serious complications of RSVA by targeting the etiology for treatment and timely surgical intervention.

Repair of a Non-coronary Sinus of Valsalva Aneurysm Rupture

Repair of a Non-coronary Sinus of Valsalva Aneurysm Rupture

Transthoracic minimally invasive closure for the treatment of ruptured sinus of Valsalva aneurysm: immediate and mid-term follow-up results.

BackgroundWe aimed to evaluate the immediate and mid-term outcomes of transthoracic minimally invasive closure (TMIC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease.MethodsFrom January 2014 to November 2020, 19 patients (16 males, 3 females) with RSVA were selected for TMIC and were followed up at our centre. Data were analysed from our prospectively collected database and clinical mid-term follow-up was obtained.ResultsAmong these 19 cases, transthoracic echocardiography showed rupture of the right coronary sinus to the right atrium in 9 patients, non-coronary sinus rupture to the right atrium in 7 patients, and right coronary sinus rupture to the right ventricle in 3 patients. Most (13/19) cases were New York Heart Association (NYHA) functional class III or IV. The mean diameters of the defect from the aortic end and ruptured site were 8.8±3.0 and 6.4±2.6 mm, respectively. TMIC was attempted using ventricular septal defect (VSD)/patent ductus arteriosus (PDA) occluders 2–7 mm larger than the aortic ends of the defects. All patients were successfully treated by TMIC and achieved complete closure at discharge after a mean hospital stay length of 6.2±2.5 days. Seventeen patients were NYHA class I while 2 patients were NYHA class II. No cases of residual shunts, device embolization, infective endocarditis, or aortic regurgitation were observed during a median follow-up of 36 months (range, 16–84 months).ConclusionsIn appropriately selected cases with RSVA, TMIC is an attractive alternative to surgery, with a high technical success rate and encouraging short-term and mid-term outcomes. However, long-term follow-up is needed.

Diagnostic Challenge of a Ruptured Sinus of Valsalva Aneurysm (RSOVA) in the Presence of Concurrent Valvular Pathology: The Utility of Multimodality Imaging

Diagnostic Challenge of a Ruptured Sinus of Valsalva Aneurysm (RSOVA) in the Presence of Concurrent Valvular Pathology: The Utility of Multimodality Imaging

Ruptured sinus of valsalva aneurysm presenting as syncope and hypotension: a case report

BackgroundUnruptured sinus of valsalva aneurysm (SOVA) are typically asymptomatic, and hence can be easily ignored. Ruptured sinus of valsalva aneurysm (RSOVA) usually protrude into the right atrium or ventricular. However, in this case, the RSOVA protruded into the space between the right atrium and the visceral pericardium leading to compression of the right proximal coronary artery. Very few such cases have been reported till date.Case presentationWe describe a case of ruptured right SOVA in a 61-year-old man with syncope and persistent hypotension. At the beginning, considered the markedly elevated troponin, acute myocardial infarction was considered. However, emergency coronary angiography unexpectedly revealed a large external mass compressed right coronary artery (RCA) resulting in severe proximal stenosis. Then, aorta computed tomography angiography (CTA) and urgent surgery confirmed that the ruptured right SOVA led to external compression of the right proximal coronary artery. Finally, ruptured right SOVA repair and RCA reconstruction were successfully performed, and the patient was discharged with no residual symptoms.ConclusionsIt is very important to be vigilant about the existence of SOVA. RSOVA should be suspected in a patient presenting with acute hemodynamic compromise, and echocardiography should be immediately performed. Moreover, it is very important to achieve dynamic monitoring by using cardiac color ultrasound. Definitive diagnosis often requires cardiac catheterization, and an aortogram should be performed unless endocarditis is suspected.

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.

Ruptured Sinus of Valsalva Aneurysm Presenting as Acute Coronary Syndrome with Cardiogenic Shock and aVR ST-Elevation - A Case Report.

A ruptured sinus of Valsalva aneurysm can present as a clinical emergency and can lead to progressively deteriorating dyspnea. We describe an unusual case of sinus of Valsalva aneurysm (SOVA) presenting with acute chest pain and dyspnea with electrocardiographic ST-segment elevation in the V1 and aVR leads. Diagnostic angiography and cardiac computed tomography angiography showed contrast enhancement from the aorta to the right ventricle and pulmonary artery. The patient was referred to a cardiovascular surgeon for immediate surgical excision and repair. This case highlights the importance of physical examination and echocardiography, especially in the emergency setting, since the disease can manifest in various presentations. To the best of our knowledge, this report may be the first described case to suggest an acute coronary syndrome with aVR ST-elevation occurring from an acute ruptured SOVA.

Medium- and long-term follow-up of transcatheter closure of ruptured sinus of Valsalva aneurysm in Central Europe population

BackgroundWe aimed to evaluate medium- and long-term outcomes of transcatheter closure (TC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease. MethodsRetrospective analysis included 23 patients (14 males) aged 15–79 years (y; 39.9±18.5) selected for TC of RSVA between 2007 and 2017 in two tertiary centers in Poland and Ukraine. Fifteen patients were in New York Heart Association (NYHA) class III or IV before TC; 5 patients had acquired RSVA after previous cardiac surgery. We applied 22 duct, 3 muscular, and 1 atrial septal Amplatzer or Amplatzer-like occluders by the anterograde venous approach after arterio-venous loop creation in all but 1 patient. Mean follow-up conducted in outpatient clinic was 5.5±3.5 (1–11)y. ResultsThe procedure was successful in 19/23 patients (82.6%). Four procedures were abandoned and the device percutaneously retrieved due to coronary artery compression (1 patient), transient increase of aortic regurgitation (AR; 1 patients) or embolization (2 patients). New onset of significant AR was noted in one of the latter patients after device removal. NYHA class improved in all treated patients but 2, in whom it remained stable (p<0.05), with 10 patients in class I. Three patients needed percutaneous re-intervention during follow-up because of significant residual shunt in 1 and late recurrent RSVA in 2 patients. The follow-up of the remaining patients was uneventful. Neither erosion, embolization, new AR, nor death were observed. ConclusionsThe percutaneous closure of RSVA is a safe and effective method of treatment with good clinical outcome. However, although not described previously, recurrent shunts after TC of RSVA are possible and can be treated successfully with another transcatheter intervention.

COMPLICATION OF SINUS OF VALSALVA ANEURYSM RUPTURE

Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly. Surgical repair is the preferred method of treatment for SVA rupture but diagnosis may be masked by several other factors. 30-year-old female with history of Ehlers-Danlos syndrome and heavy alcohol use presented intubated due to seizures

Safety and efficacy of percutaneous closure of ruptured sinus of Valsalva aneurysm.

The aim of this study was to evaluate the safety and efficacy of percutaneous closure in patients with a ruptured sinus of Valsalva aneurysm (RSVA). A total of 29 patients with RSVA were retrospectively enrolled in our study. All patients were successfully treated by percutaneous closure and had a complete closure at discharge; however, two patients had a trivial procedure-related aortic regurgitation (AR) after the procedure. On a mean follow-up of 29.7±23.8 months (range 1-83 months), the two procedure-related AR disappeared three months and two years after the procedure, respectively. Trivial residual shunt was found in one patient, sinus of Valsalva aneurysm ruptured again in one patient and trivial to moderate AR was found in two patients during the follow-up. In appropriately selected patients with RSVA, percutaneous closure is an attractive alternative to surgery with high technical success and good short-term and midterm outcomes; however, long-term follow-up is mandatory.

GW29-e1596 Safety and efficiency of percutaneous closure of Ruptured Sinus of Valsalva Aneurysm

To evaluate the safety and efficiency of percutaneous closure (PC) in patients with ruptured sinus of Valsalva aneurysm (RSVA). Between April 2005 and November 2015, a total of 35 patients (18 males and 17 females) aged 7-72years (mean 38.2±16.5 years) with RSVA were treated by PC in our hospital

TCT-277 Safety and feasibility of Trans Catheter interruption of ruptured sinus of Valsalva aneurysm (RSOVA) using the Coccoon Duct Occluder (CDO): immediate results and mid-term follow-up

Limited data is available regarding safety and feasibility of transcatheter interruption of ruptured sinus of Valsalva aneurysm (RSOVA) using the Coccoon duct occluder (CDO) with immediate and mid-term follow-up result. TCC was successfully done among 10 patients whereas 5 cases, not amenable to

Clinical outcomes of percutaneous or surgical closure of ruptured sinus of Valsalva aneurysm.

To evaluate the clinical efficacy, safety, and long-term outcomes of percutaneous closure (PC) and surgical repair of ruptured sinus of Valsalva aneurysm (RSVA). Eighty-five consecutive patients with RSVA were included in this study. Patients were considered candidates for PC if they met the criterion, surgical repair was performed on patients who were unsuitable or failed PC. Of them, 30 patients underwent PC, while the other 55 patients had surgical repair. RSVA was successfully occluded in 29 of 30 patients who were treated by PC. The mean narrowest diameter at the ruptured site was 6.45 ± 1.60 mm measured by aortography. One patient developed serious occluder-related aortic regurgitation and underwent surgery. The success rate of the interventional approach was 96.7%. In the surgical group, 23 patients underwent repair of combined RSVA and ventricular septal defect. The hospital mortality rate of the surgical approach was 3.57%. During a median follow-up of 83 months (8-152 months), the improvement in NYHA functional class in the PC group was significantly greater than those in the surgical group (P < .01). One patient died of infective endocarditis in the surgical group. There were no further serious complications. PC is a safe alternative to surgical repair for patients with isolated RSVA. Surgical repair is more suitable for those who have multiple cardiac lesions requiring surgical treatment or failed PC.

Rupture of sinus of Valsalva aneurysm: Two case reports and a concise review of the literature

BackgroundThe rupture of sinus of Valsalva aneurysm (RSoVA) is a rare disorder that affects the integrity of the cardiovascular system, disrupting its dynamics and resulting in a variety of manifestations. In this report, we discuss two cases of RSoVA that we encountered and review similar cases reported in the literature. Methodsliterature review of reported cases of RSoVA in PubMed and Google Scholar. ResultsA total of 223 cases were found and the final analysis included 225 cases, of which 69% occurred in males and the mean age was 38.9 years.Dyspnea was the most common presenting symptom and 76% of the cases described continuous murmur on examination. The right sinus was affected in 61% of the cases and the fistula connected to the right chambers of the heart 73% of the time. ConclusionRSoVA is a rare condition that is difficult to diagnose, it should be considered in the right context, particularly in young patients with symptoms of heart failure and the presence of continuous murmur on cardiac examination.

Percutaneous device closure of a ruptured sinus of valsalva presenting in acute heart failure

Aneurysms of sinus of valsalva are rare cardiac abnormalities1. Following rupture it presents with acute heart failure. Definitive treatment is surgical or device closure2. A 25-year-old female presented with decompensated cardiac failure following a ruptured sinus of valsalva aneurysm (RSOVA). She underwent percutaneous device closure at the Cardiology Unit of the National Hospital of Sri Lanka (NHSL) and had an uneventful follow up for one year. This is the first successful closure of a RSOVA by a Sri Lankan team of cardiologists. The procedure is safe and feasible and can be performed with available facilities in selected patients.