Unruptured Sinus Of Valsalva Aneurysm Research Articles

Unruptured Sinus of Valsalva Aneurysm Coexisting with Ventricular Septal Defect

Unruptured sinus of valsalva aneursym is an incidental, relatively rare finding on cardiac imaging and is often found in association with other cardiac defects with ventricular septal defect as the commonest. It presents a diagnostic challenge on transthoracic echocardiography in coexistence with ventricular septal defect in adulthood, mimicking other cardiac defects. Unruptured sinus of valsalva aneurysm coexisting with ventricular septal defect usually presents with symptoms of rupture—a surgical emergency in the third and fourth decade of life. We report a case of a 24-year-old single mother referred to the Cardiology Clinic of the University of Nigeria Teaching Hospital with 5 months symptoms of heart failure. Investigations showed cardiomegaly, prominent pulmonary conus, and upper lobe vessel diversion on chest x-ray. There were bigeminal premature ventricular contractions, left atrial abnormality, biventricular hypertrophy with a right strain on electrocardiogram, and bidirectional membranous ventricular septal defect with right sinus of valsalva aneurysm on transthoracic echocardiography.

Sinus of Valsalva Aneurysm in Females.

Sinus of Valsalva aneurysm (SVA) is a rare cardiovascular disease with male predominance. Recently, an association with aortic aneurysm and SVA has been revealed in periventricular nodular heterotopia patients with loss-of-function Filamin A (FLNA) mutations, which were located on chromosome X and almost exclusively affect females.Among patients hospitalized for aortic surgery with aortic root diameter over 4.0 cm, next-generation sequencing was performed to investigate 30 candidate genes related to inherited aortic aneurysm syndromes and familial thoracic aortic aneurysm and dissection. The present report reviewed an electronic case database and identified two female cases of unruptured SVA with heterozygous FLNA truncating mutations.Case 1 displaying a rare SVA phenotype involving left and noncoronary sinus harbored a nonsense variant p.Tyr1720Ter/c.5160C > G. Case 2 displayed right and noncoronary SVA with predominantly enlarged right coronary sinus, posterior mitral valve prolapse, and harbored a frameshift variant p.Val1724fs*68/c.5171_5172delTG. Both novel mutations resulted in the premature termination of filamin A with the loss of functional Rod 2 and dimerization region.The present report raised the possibility of the presence of a cardiovascular onset form in the spectrum of FLNA hereditary diseases. The association between SVA and loss-of-function FLNA mutations indicates a unique etiology and pathogenesis among female patients, which requires further investigation to establish the linkage between FLNA variants and a wide spectrum of phenotypes.

Surgical Repair of a Sinus of Valsalva Aneurysm.

A surgically challenging case of an unruptured Sinus of Valsalva aneurysm (SoVA) with severe aortic regurgitation (AR) due to cusp prolapse is presented. Sinus reconstruction with a patch cut out from the sinus portion of a Gelweave Valsalva graft (Terumo Vascutek) was performed. Intraoperative measurements showed insufficient effective height of the right coronary cusp; therefore, cusp plication and pericardial patch augmentation of the right coronary cusp were performed with satisfying result.

A Rare Case of Giant Unruptured Sinus of Valsalva Aneurysm

Sinus of Valsalva aneurysm is a rare congenital disorder that usually presents with rupture of the aneurysm into adjacent cardiac structures. It usually arises from the right sinus of Valsalva which ruptures into the right ventricle or right atrium (RA). Aneurysms may also arise from the noncoronary cusp that rupture into RA. Rarely, an unruptured aneurysm may compress or dissect into the adjacent structures and produce obstruction to either left or right ventricular outflow or produce conduction blocks. It may also intrude upon valves affecting valvular function. Here is a case of an unruptured giant aneurysm arising from the right sinus of Valsalva burrowing into the interventricular septum (IVS) causing conduction defect in the form of left bundle branch block with first degree atrioventricular block. Through IVS, it protruded into the left ventricular (LV) outflow tract (LVOT) giving rise to a cystic appearance causing mild LVOT obstruction and mild-to-moderate aortic regurgitation. The aneurysm also affected mitral valve function causing severe mitral regurgitation (MR) including characteristic diastolic MR due to prolonged PR interval. There was no regional wall motion abnormality indicating the absence of coronary arterial obstruction by the aneurysm. Left atrial and LV dilatation was present along with LV systolic dysfunction. Pulmonary arterial systolic pressure was approximately 48 mmHg as calculated from tricuspid regurgitation (TR) gradient. Like MR, TR also showed diastolic TR.

Abstract 10428: Bad Fall, Good Catch: Diagnosing a Rare Condition Presenting as Acute Coronary Syndrome

A 72 year-old mountain bicyclist suffered a biking accident. The following week, he presented to the emergency room with abdominal pain, where he was treated for superior mesenteric artery thrombosis and new-onset atrial fibrillation. Two months later, he presented with intermittent left scapular pain that radiated to the chest. Pharmacologic stress testing revealed a large reversible perfusion defect in the anterior wall with an ejection fraction of 41%. Left heart catheterization showed narrowing of the distal left main coronary artery and the proximal left anterior descending (LAD) and circumflex arteries, by what appeared to be external compression. Follow-up CT angiogram demonstrated two sinus of Valsalva aneurysms (SOVA) originating from the left and right coronary cusps. A transesophageal echocardiogram confirmed these findings and showed tremendous thrombus within the larger aneurysm. The patient was admitted to cardiothoracic surgery. Troponin was elevated to 0.16 μg/L, with EKG showing 1 mm ST-segment depressions in V4-6, prompting treatment for a non-ST segment myocardial infarction. He underwent complex surgery involving thrombus extraction and closure of the SOVA with pericardial patch repair, and coronary artery bypass grafting of the LAD and obtuse marginal arteries. After a prolonged ICU course in which the patient was managed for cardiogenic shock, he was discharged to a hospital equipped with a rehabilitation facility. Unfortunately, he developed profound lactic acidosis from ischemic bowel and passed away. SOVA are rare lesions that arise from congenital or acquired etiologies, such as this patient’s biking accident. Multi-modality imaging is important for quantifying size and anatomy. Unruptured SOVA can present as embolic phenomenon from thrombus, valvular regurgitation, or chest pain from compression of the coronary arteries. Rupture is a highly morbid condition, and so urgent referral to cardiothoracic surgery is recommended.

Surgical Interventions Are Effective for Treating Unruptured Sinus of Valsalva Aneurysms.

Background: This study investigates the optimal management for unruptured sinus of Valsalva aneurysms (USVAs) combined with other cardiovascular lesions.Methods: This retrospective study examined 33 USVA patients who underwent surgical repair from February 1, 2007 to January 31, 2012. We analyzed the surgical procedures and the patients' quality of life after surgery. Additionally, echocardiography follow-up was performed before and after the operation.Results: Most USVAs (87.8%) originated in the right coronary sinus. Aside from one patient who was preoperatively misdiagnosed as having a ruptured sinus of Valsalva aneurysm (SVA). USVAs of the right coronary sinus were addressed by reinforcing this sinus with a Dacron patch through the right ventricle. USVAs were corrected by aortotomy using an autogenous pericardium patch when they originated in the non-coronary or left coronary sinus. Thirty patients (90.9%) were followed up for 22–119 months. No early death, residual fistula or SVA recurrence were found during the follow-up period. They all had a good quality of life and good heart function (New York Heart Association class I–II).Conclusions: Active surgical repair of an USVA can be achieved with satisfactory results in patients combined with other cardiovascular lesions.

Surgical management for unruptured sinus of Valsalva aneurysms: a narrative review of the literature.

Unruptured sinus of Valsalva aneurysms (SVAs) are rare cardiac lesions that arise due to congenital or acquired etiologies. They could be asymptomatic or cause various clinical manifestations as a consequence of their mass effect on the coronary arteries, heart valves, and other adjacent structures. While the factors predicting SVA rupture are not fully understood, ruptured SVAs carry a high complication and mortality rate, highlighting the need for early recognition and management of unruptured SVAs. Imaging modalities such as echocardiography, computed tomography (CT), angiography, and magnetic resonance imaging (MRI) are essential in identifying and characterizing the aneurysm as well as associated cardiac anomalies. However, there are no specific guidelines for the diagnosis and management of SVAs. Herein, we performed a contemporary systematic review to examine the presentation, diagnostic tests and findings, as well as outcomes for surgical intervention of unruptured SVAs. We demonstrate that surgical repair remains the preferred method of treatment in order to prevent complications such as rupture or thrombus formation. Surgery should be prompted in patients with symptomatic, large, or rapidly expanding unruptured SVAs, as well as those unruptured SVAs that contain intraluminal thrombi, have a mass effect on surrounding structures, or are recurrent. Surgical outcomes are generally good with favourable prognosis and minimal recurrence.

Anesthetic Management of a Patient with Unruptured Sinus of Valsalva Aneurysm with Right Ventricular Outflow Tract Obstruction

Anesthetic Management of a Patient with Unruptured Sinus of Valsalva Aneurysm with Right Ventricular Outflow Tract Obstruction

Unruptured sinus of valsalva aneurysm, with dissection into the interventricular septum

Sinuses of Valsalva or aortic sinuses are 3 focal expansions at the root of the aorta and are named right, left and non-coronary sinuses. These sinuses serve as support system for the aortic valve and prevent occlusion of the coronary ostia as the aortic cusps open in systole. Sinus of Valsalva aneurysm (SOVA) is congenital in most cases, due to deficiency of the elastic lamina between the aortic media and the annulus fibrosus. The anatomical location of these sinuses can predict some clinical consequences, when complications occur. We report the case of a 29yr old Nigerian man who presented at the accident and emergency unit of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, with clinical features of heart failure. Electrocardiography showed complete heart block, and later supraventricular tachycardia, while echocardiography showed a right sinus of valsalva aneurysm dissecting into the interventricular septum, without evidence of rupture.

Sinus of valsalva aneurysm repair in an octogenarian using CorMatrix ECM®

Introduction: Unruptured sinus of Valsalva aneurysms are surgically treated after change in clinical presentation or increased size on serial echocardiography. Prostheses such as Dacron grafts and Gortex are notably used, but use of CorMatrix has not previously been reported. The following case presents the first reported use of CorMatrix for sinus of Valsalva repair. Presentation of case: An 84-year-old male presented with a 6.3 cm right sinus of Valsalva aneurysm seen with echocardiography. Surgical sinus of Valsalva repair involved inserting BioGlue within the aneurysm and closing the defect with CorMatrix. Twomonth follow-up showed no significant postoperative complications. Discussion: The presented case reports the first use of CorMatrix for sinus of Valsalva repair and represents the oldest patient in the world to undergo this surgery. Sinus of Valsalva aneurysms are asymptomatic in 25% of cases and are incidentally found with echocardiography. Although survival in elderly patients specifically is unknown, postoperative survival overall is 88% at 20 years. CorMatrix is commonly used for structural heart defect repairs, but has not been described for sinus of Valsalva repairs. Conclusions: CorMatrix presents as a suitable prosthesis for sinus of Valsalva aneurysm repair.

Surviving All Odds: A Unique Case of Multiple Congenital Unruptured Sinus of Valsalva Aneurysms Involving Both Left and Right Coronary Sinuses with Biventricular Dysfunction and Heart Block.

Aneurysms of the sinus of Valsalva are very uncommon, with an incidence ranging from 0.1 to 3.5% of all congenital heart defects. Very few cases have been reported in the literature that presented with involvement of two or more sinuses. We report a case of 27-year-old male with a history of exertional breathlessness of one-month duration. After complete evaluation using transesophageal echocardiography (TEE) and multiple detector computed tomography (MDCT) scanning, the patient was diagnosed to have large congenital unruptured sinus of Valsalva aneurysms involving both left and right coronary sinuses with extension into the interventricular septum. The patient also displayed second-degree heart block (Mobitz type 2) and biventricular dysfunction. The patient was managed successfully. We present the case with an aim to highlight the management challenges including intraoperative and postoperative complications that are associated with unruptured sinus of Valsalva aneurysms of ≥2 sinuses.

Giant unruptured sinus of Valsalva aneurysm with complete heart block

In this rare case report of giant unruptured sinus of Valsalva aneurysm (SOVA), a 17-year-old male presented with sudden onset syncope due to complete heart block (CHB). An emergency evaluation was done with the help of transthoracic echocardiography, transesophageal echocardiography, and cardiac catheterization with support of temporary pacemaker. The obvious distorting effects of a giant SOVA dissecting into interventricular septum were CHB, significant regurgitation of tricuspid and mitral valve, mild regurgitation aortic valve and biventricular dysfunction. The case was treated by repair of SOVA and posterior mitral ring annuloplasty. CHB improved to sinus rhythm on 11th day after surgery. On follow-up, tricuspid valve regurgitation improved to mild regurgitation and he continued to have mild aortic regurgitation.<Learning objective: Sinus of Valsalva aneurysm (SOVA) may present with cardiac emergency without rupture. A giant unruptured SOVA competes for space with neighboring intra cardiac structures. The distorting effects are erosion into interventricular septum, complete heart block (CHB), valvular and ventricular dysfunction. Transthoracic and transesophageal echocardiography provide enough information for emergency surgery. Sometimes, evaluation may need cardiac catheterization and computed tomography. Immediate surgery saves life. CHB may improve on follow-up.>

Red Herring: Unruptured Sinus of Valsalva Aneurysm Presenting as Hepatobiliary Disease

SESSION TITLE: Cardiovascular Disease Student/Resident Case Report Posters SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Sinus of Valsalva Aneurysms are rare entities with an incidence of 0.14-0.23%. Unruptured aneurysms are usually innocuous and are usually incidental findings on imaging. We report a case of unruptured SVA causing pseudo tricuspid stenosis whose initial presentation mimicked acute cholecystitis. CASE PRESENTATION: A 36-year-old male presented to the emergency department with a 12-day history of progressively worsening abdominal pain and shortness of breath with associated sweats, chest heaviness, nausea, vomiting and diarrhea. He denied fevers, chills, rigors or sick contacts. Eleven days before presentation he was admitted for similar symptoms and treated for possible cholecystitis. Physical examination revealed a middle-aged man in respiratory distress with stable vital signs. Significant findings included an elevated JVD, a II/VI systolic and II/VI diastolic murmur, with tender hepatomegaly and guarding over the right upper quadrant. He also had pitting pedal edema. Laboratory tests revealed transaminitis, hyperbilirubinemia, elevated INR, acute kidney injury and elevated lactate. His electrocardiogram was suggestive of right atrial enlargement. A transesophageal echocardiogram confirmed a large saccular aneurysm measuring approximately 4 cm in diameter that impinged on the tricuspid valve causing tricuspid stenosis. Intraoperatively, a cyst was found in the right atrium with a connecting fistula arising from the non-coronary cusp of the aorta that was excised and repaired. The patient had an uneventful post-operative recovery and was discharged seven days after surgery. DISCUSSION: Although unruptured sinus of valsalva aneurysms are usually asymptomatic, they may present with symptoms of right ventricular outflow tract obstruction. This may cause congestive hepatopathy and mimic a primary hepatobiliary disease as in our patient. A systolic-diastolic thrill, right upper quadrant tenderness and evidence of synthetic liver dysfunction were clues to this uncommon diagnosis. CONCLUSIONS: Unruptured sinus of valsalva aneurysms may present with signs and symptoms of extra-cardiac disease. A detailed medical history and thorough physical examination is crucial to early diagnosis and appropriate management. Reference #1: Goldberg N, Krasnow N. Sinus of valsalva aneurysms. Clin Cardiol. 1990;13(12):831-836. doi:10.1002/clc.4960131204. Reference #2: John S-H. A rare case of unruptured sinus of valsalva aneurysm obstructing the right ventricular outflow tract. J Cardiovasc Ultrasound. 2010;18(2):55-57. doi:10.4250/jcu.2010.18.2.55. Reference #3: Bricker AO, Avutu B, Mohammed T-LH, et al. Valsalva Sinus Aneurysms: Findings at CT and MR Imaging1. 2010. http://pubs.rsna.org/doi/full/10.1148/rg.301095719. Accessed December 30, 2014. DISCLOSURE: The following authors have nothing to disclose: Gbolahan Ogunbayo, Shanchiya Ravindradas, David Lobo, Dipekka Soni, Seth Jacobson No Product/Research Disclosure Information

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.

A case of unruptured sinus of Valsalva aneurysm of the two coronary sinuses obstructing the right ventricular inflow and outflow tract with an anomalous origin of the coronary artery

A case of unruptured sinus of Valsalva aneurysm of the two coronary sinuses obstructing the right ventricular inflow and outflow tract with an anomalous origin of the coronary artery

Unruptured Aneurysm of Sinus of Valsalva Coexisting with the Large Ventricular Septal Defect and Severe Aortic Regurgitation in a Young Man.

Introduction. Unruptured sinus of valsalva aneurysm (SVA) is a rare congenital anomaly, particularly, when it coexists with a ventricular septal defect (VSD) and aortic regurgitation due to the prolapse of the elongated aortic cusp into the VSD. In this report, we present the case of a 19-year-old young man with VSD challenging in spite of dyspnea and lower limb edema. Presentation of Case. Its diagnosis was made on the basis of transthoracic echocardiography results. Surgical management consisted of replacing the SVA with mechanical valve prosthesis. A Gore-Tex patch repaired the VSD. Discussion. In the follow-up periods, clinical and echocardiographic tests showed that the patient was in excellent status. Conclusion. SVA requires a surgical procedure due to its high risk of mortality in unoperated patients and a good safety of surgery.

English

An unruptured sinus of valsalva aneurysm can dissect into the interventricular septum (IVS) and cause complete heart block, but a ruptured aneurysm causing complete heart block is rare. We present the case of a young male with ruptured aneurysm into IVS of the right coronary sinus of Valsalva with complete heart block diagnosed by transthoracic echocardiography and

Multiple Recurrent Sinus of Valsalva Aneurysms

We report a case of multiple unruptured sinus of Valsalva aneurysms in an adult patient over nine years.

An unusual cause for unruptured sinus of valsalva aneurysm

Sinus of valsalva aneurysm is considered to be one of the rarest complications of inflammatory aortitis. Herewith, we are reporting a young male patient who presented to us with severe aortic regurgitation. On evaluation, he was found to have unruptured sinus of valsalva aneurysm. CT angiography and magnetic resonance imaging have shown value in the diagnosis of sinus of valsalva aneurysm.

Simultaneous Repair of a Sinus of Valsalva Aneurysm and a Bicuspid Aortic Valve

Sinus of Valsalva aneurysms (SOVA) are rare cardiac abnormalities that are most commonly congenital in origin and frequently associated with aortic valve pathology. Unruptured SOVA are more frequently identified currently, owing to the increased use and accuracy of diagnostic investigations. Early surgical intervention is recommended to prevent complications. We describe a case of a young patient with an enlarging right SOVA and a regurgitant bicuspid aortic valve who subsequently underwent simultaneous patch repair of the SOVA and primary aortic valve repair.