Valsalva Aneurysm Research Articles

Potential Role of Cardiac Computed Tomography in Establishing Diagnosis of Ruptured sinus of Valsalva Aneurysm: Case Report

Ruptured Valsalva aneurysm is a rare cardiac anomaly that may be congenital or acquired, a coexisting cardiac lesion might be present. The presentation may range from an asymptomatic murmur to cardiogenic shock. Most of these cases were earlier diagnosed using echocardiography and conventional angiography. But with the availability of advanced imaging modalities like cardiac CT this condition can be accurately assessed noninvasively. The high spatial resolution of cardiac CT provides anatomical details of the aneurysm by depicting a jet of contrast materials extending from the aneurysm and adjacent cardiac chamber. We report a case of ruptured aneurysm arising from the non-coronary sinus with a fistulous track connecting the sinus with the right atrium. This case was evaluated by 32 slice cardiac MDCT (Multi detector computed tomography) imaging. This was later confirmed peroperatively.
 Ibrahim Cardiac Med J 2014; 4(2): 64-67

A Large, Unruptured, Aneurysm of Right Sinus of Valsalva, Extending Behind the Main Pulmonary Artery Associated with Bicuspid Aortic Valve-a Rarest Presentation

Background: Aneurysm of Sinus of valsalva is caused due to lack of the continuity between the middle layer of the aortic wall and aortic valves. Case report: A patient presented with dyspnoea and chest pain. Computed tomographic angiocardiography revealed dysplastic aortic valve and aneurysm of right sinus of valsalva. We presenting here a case with bicuspid aortic valve complicated with aneurysm of right sinus of valsalva. The aneurysm of sinus of valsalva was extracardiac and extending behind the main pulmonary artery and to the left. Computed tomographic angiocardiography revealed dysplastic aortic valve, para valvular aneurysmal sac communicating with aortic root as well as to left ventricle (? Pseudo-aneurysm). Opening of the aneurysm of sinus of valsalva was closed with Dacron patch from inside of the aorta. Aortic valve was replaced with sorin mechanical valve, size 21. Postoperative period was uneventful and patient was discharged on 7th postoperative day in good general condition. Patient is doing well in follow up visits. Discussion: This is associated with other heart defects, Ventricular septal defect in 30-60%, bicuspid valve (10%), and aortic stenosis (6.5%). Sinus of valsalva aneurysm recurrence per se is rare [1,2]. There is no doubt of the indication of surgical repair for symptomatic Sinus of valsalva aneurysm because this represents a significant risk of death. Operative mortality is generally low. Conclusion: This is the rare presentation of the aneurysm of right sinus of valsalva and is first time in literature because of following reasons. a. Aneurysm of sinus of valsalva was originating from the right sinus and was extending behind the main pulmonary artery. b. This was compressing the left anterior descending artery and causing angina like symptoms. c. This was associated with bicuspid aortic valve which is also a rare occurrence (10%) with aneurysm of sinus of valsalva.

Usefulness of Computed Tomography in the Diagnosis of Ruptured Sinus of Valsalva Aneurysm

Rupture of sinus of Valsalva aneurysm (SVA) is a fatal complication, and early detection and immediate surgical correction is critical for lifesaving. However, achieving its definite diagnosis is challenging. Computed tomography (CT) can provide excellent diagnostic value for SVA rupture and other combined anomalies with better spatial resolution of cardiac structure. Herein, we described a case of a young woman with ruptured SVA. SVA rupture was suggested by transthoracic echocardiography and confirmed by cardiac CT. CT scan confirmed SVA rupture by revealing a ring-like structure originating from the right coronary sinus of the aortic valve protruding to the right ventricle with extravasation of the radiocontrast agent. This finding was not clearly defined by transthoracic echocardiography. Cardiac CT may be useful for the diagnosis of ruptured SVA by providing more detailed visualization of adjacent structures and additional information on combined cardiac pathology.

Ruptured Sinus of Valsalva Aneurysm Complicating Infective Endocarditis: A Case Report

Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, usually congenital but may be acquired & rarely ruptures. A 24- year- old male presented with a history of prolonged fever, loss of appetite and significant weight loss along with exertional dyspnoea, palpitation and mild chest pain together with clubbed fingers and toes, mild splenomegaly and a continuous machinery murmur over the left sternal edge with associated thrill. Transthoracic echocardiogram revealed ruptured sinus of Valsalva aneurysm with shunt from aorta to right atrium (RA) and vegetation. He was diagnosed as infective endocarditis with rupture of sinus of Valsalva aneurysm and treated with antibiotics and referred to the cardiothoracic surgeon for repair of ruptured SVA.Birdem Med J 2015; 5(1) Supplement: 52-55

Echocardiographic features of sinus of Valsalva aneurysm extending into left ventricle

To observe image features of sinus of Valsalva aneurysm (SVA) extending into left ventricle by echocardiography. Echocardiographic features of 5 cases of SVA extending into left ventricle and underwent surgery at Union Hospital from July 1995 to September 2015 were reviewed retrospectively and image and surgical findings were compared. A total of 4 patients were diagnosed by conventional and 3D echocardiography before surgery, and 1 patient was diagnosed by conventional echocardiography. The origin, extending position, rupture status, complications of the SVA and associated cardiovascular lesions determined by echocardiography were entirely consistent with surgical findings in all cases, with the exception of one failed diagnosis of hypoplasty of an adjacent aortic cusp. Besides the common features of SVA, echocardiographic features of SVA extending into left ventricle included a thin-walled saccular lesion arising from the aortic root in continuation with the aortic annulus, with significant morphological changes and movement. Moreover, following features were observed: very low origin of the saccular lesion arising between the sinus base and the aortic annulus; the aneurysm going back and forth between the aortic root and the left ventricular outflow tract in 4 cases with an intact interventricular septum, and between the left ventricle and the right ventricle through the septal defect in another case complicated by a huge ventricular septal defect; diastolic shunt into the left ventricle when ruptured; displacement of the adjacent aortic annulus due to compression of aneurismal origin and prolapse of both aortic valve and annulus observed in all cases, resulting in a severe aortic regurgitation; obstructions of the left ventricular outflow tract due to the space-occupying effect were also found in 2 cases. The SVA extending into left ventricle has distinguished echocardiographic characteristics, which could be accurately diagnosed either by conventional or real-time 3D echocardiography.

Is the Sac Waiting to Rupture? Sinus of Valsalva Aneurysm

Completely asymptomatic sinus of Valsalva aneurysms are rare entities, and there is no consensus regarding their management. We present the case of a patient who underwent atrial septal defect device closure at 5 years of age and was lost to follow-up, then presented 6 years later with unruptured sinus of Valsalva aneurysm and was closely followed. The aneurysm eventually ruptured and was successfully operated on with good outcomes.

Potential chronic abscess cavity that masqueraded as sinus of valsalva aneurysm: is TOE a most vital tool?

Potential chronic abscess cavity that masqueraded as sinus of valsalva aneurysm: is TOE a most vital tool?

A Rare Complication of Behcet’s Disease: An Incidentally Detected and Spontaneously Thrombosed Sinus of Valsalva Aneurysm

A Rare Complication of Behcet’s Disease: An Incidentally Detected and Spontaneously Thrombosed Sinus of Valsalva Aneurysm

Ruptured aneurysm of right sinus of valsalva - a case report

The sinus of valsalva aneurysm (SVA) is a small dilatation caused by a separation between the aortic media and annulus fibrosus. It may be either acquired or congenital. The right coronary sinus is most frequently affected, with the most common complication being rupture of the sinus. Cardiac failure and sudden auscultation changes suggest the possibility of SVA rupture. Echocardiography is sufficient to diagnose SVA, its complications, repercussions and to determine surgical options. SVA, even if asymptomatic, has potential risks of expansion, rupture, cardiac failure, endocarditis, embolism and sudden death. This justifies surgical correction which has a low mortality rate in both the short and long-term.Bangladesh Med J. 2015 Sep; 44 (3): 175-177

Rupture of sinus of valsalva aneurysm: earliest presentation in association with ventricular septal defect and aortic regurgitation

Rupture of sinus of Valsalva aneurysm (SVA) is a rare cardiac lesion, generally occurring in second to fourth decades of life. Ruptured SVAs are frequently associated with other congenital defects, particularly with ventricular septal defect, aortic valve regurgitation, and bicuspid aortic valve. The malformation arises due to lack of continuity between the aortic media and the annulus fibrosus of the aortic valve. The structure becomes aneurysmal and may rupture to form a fistula. They are rare in paediatric patients. We describe here, a four year old female child being managed previously as a case of ventricular septal defect and aortic regurgitation deteriorates progressively. Transthoracic echocardiography revealed rupture of sinus of valsalva aneurysm into the right ventricle along with ventricular septal defect with aortic regurgitation. We report here earliest presentation of ruptured sinus of valsalva aneurysm which had been misdiagnosed as ventricular septal defect.

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.

Bicuspid aortic valve with severe stenosis and ruptured sinus of Valsalva aneurysm to left ventricle

Bicuspid aortic valve (BAV) is a common congenital cardiac anomaly, and rarely, it is associated with sinus of Valsalva aneurysms (SOVAs). And very infrequently, these SOVAs rupture into left side of heart. We hereby report a case of 12-year-old male with BAV with severe aortic stenosis with a large SOVA that ruptured into the left side of the heart. The anatomy was delineated with multimodality imaging; initially with two-dimensional trans-thoracic echocardiography (TTE), and later on with three-dimensional TTE and with multi detector computed tomography. Operative interventions were planned for the patient.

Surgical Repair of a Sinus of Valsalva Aneurysm Ruptured into the Right Atrium Diagnosed After a Non-Penetrating Chest Trauma

Surgical Repair of a Sinus of Valsalva Aneurysm Ruptured into the Right Atrium Diagnosed After a Non-Penetrating Chest Trauma

Extrinsic coronary squeeze in the left main coronary artery between left sinus of Valsalva aneurysm and left auricula

A 57-year old female was evaluated due to complaint of chest pain, which was dull and unrelated to exertion. No abnormality was detected on physical examination, and left sinus Valsalva aneurysm (SVA) was revealed on echocardiography. Multi-slice cardiac computed tomography had been performed for more detailed analysis, during which the SVA was discovered (Figure A). The location of the left main coronary artery between the left SVA and left auricula was observed (Figure B). The aneurysm caused noticeable indentation (Figure C) on tomography, and myocardial perfusion scintigraphy was performed to investigate the presence of coronary ischemia, which was found on the anterior wall. Due to possible occurrence of malignant arrhythmias, coronary infarct, and sudden death, surgical intervention was recommended. 445

Case report. Longitudinal Echo Monitoring in Fetus with Phenotypical Marfan Syndrome, Helpfull for Perinatal Management - Case Presentation and Literature Review

Abstract It was the second pregnancy of an otherwise healthy married couple. The fetus (male) had detailed echocardiography monitoring in the second half of the pregnancy due to progression of cardiomegaly, and echocardiographic features of congestive heart failure. Marfan syndrome was suspected based on cardiac anomalies. For the first time, the rupture of aneurysm of aortic sinus Valsalva was documented. Despite transplacental treatment with digoxin there was fetal demise at the 34th week of gestation and postmortem newborn phenotype confirmed prenatal diagnosis. Marfan Syndrome is a rare genetic anomaly which can be diagnosed prenatally by detailed echocardiography, usually with bad prognosis (just opposite to “benign” case diagnosed later on in life span). The most common prenatal cardiac manifestations are cardiomegaly with signs of cardiac insufficiency. We present the case with new echocardiographic features.

巨大未破裂左冠尖バルサルバ洞動脈瘤の1例

症例は40歳男性．胸痛で発症し，CT，心エコーで左冠尖の巨大バルサルバ洞動脈瘤が発見され当科入院となった．左冠動脈主幹部の軽度狭小化も認められた．重度大動脈閉鎖不全症を伴っており，破裂の危険性も考慮して準緊急手術を行った．手術は大動脈基部置換術を施行したが，人工心肺からの離脱困難であったため冠血流低下を疑い，冠動脈バイパス術を追加して血行動態の改善をみた．術後経過は良好であった．左冠尖に発生するバルサルバ洞動脈瘤は稀であるが，瘤拡大に伴う圧排による心虚血症状を伴うこともあり，早期の治療を要するものと思われた．

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.

Perioperative Transesophageal Echocardiographic Diagnosis of Membranous Interventricular Septal Aneurysm in Two Patients

ABSTRACT Aneurysms of interventricular septum are a rare anomaly usually seen as an incidental finding on echocardiography. Rarely, they can cause right ventricular outflow tract obstruction. They can present in patients having other cardiac lesions. Diagnosis of interventricular septal aneurysm is not straightforward. They can be confused with sinus of valsalva aneurysm or ventricular septal defect on transthoracic echocardiography. Transesophageal echocardiography (TEE) provides a better alternative to delineate the interventricular septal aneurysm. We describe the TEE diagnosis of membranous interventricular septal aneurysm in two dissimilar patients who presented for cardiac surgery at our cardiac center. How to cite this article Dutta V, Negi SL, Puri GD, Singh RS. Perioperative Transesophageal Echocardiographic Diagnosis of Membranous Interventricular Septal Aneurysm in Two Patients. J Perioper Echocardiogr 2016;4(1):14-16.

低エネルギー外傷後に破裂したバルサルバ洞動脈瘤の1例

低エネルギー外傷後に破裂したバルサルバ洞動脈瘤の1例

Role of Transesophageal Echocardiography in Rupture of Sinus of Valsalva Aneurysm with Associated Infective Endocarditis

ABSTRACT Introduction Sinus of Valsalva aneurysm (SOVA) may have associated infective endocarditis in which case single aneurysm may drain into adjacent chamber of heart via multiple openings. We report a rare case of congenital SOVA with associated infective endocarditis where intraoperative transesophageal echocardiogram (TEE) helped in localizing two separate openings in the SOVA draining into right ventricle and an associated perforation in the larger rightward cusp of bicuspid aortic valve (BAV) causing severe aortic regurgitation. Case report A 28-year-old male presented with grade III to IV dyspnea with previous history of infective endocarditis. Preoperative transthoracic echocardiogram (TTE) showed calcified BAV with severe aortic valve regurgitation and stenosis, severe tricuspid regurgitation, and pulmonary artery hypertension along with ruptured SOVA arising from right coronary sinus and draining into the right ventricle. Intraoperative TEE confirmed the TTE findings and in addition showed the presence of two jets arising from the SOVA draining into right ventricle, a subaortic membrane, and a perforation in the aortic cusp opening into left ventricle. The ruptured SOVA was repaired using single patch technique and aortic valve was replaced. The completeness of the repair was checked using TEE to exclude failure of closure of additional opening if any and the patient was discharged from hospital after 7 days of uneventful postoperative course. Conclusion Sinus of Valsalva aneurysm may have multiple openings draining into adjacent chamber, particularly if associated with infective endocarditis. Intraoperative TEE plays a crucial role in identification of multiple opening, involvement of adjacent structure, and assessment of completeness of repair. How to cite this article Kumar B, Munirathinam GK, Sharma P, Puri GD, Singh H. Role of Transesophageal Echocardiography in Rupture of Sinus of Valsalva Aneurysm with Associated Infective Endocarditis. J Perioper Echocardiogr 2016;4(2):59-63.