Valsalva Aneurysm Research Articles

David V procedure and hemiarch replacement in a patient with Loeys-Dietz-Syndrome and beta thalassemia minor: a case report

We report the case of a 36-year-old European female patient presenting with a sinus valsalva aneurysm of 47 mm with moderate aortic regurgitation. Additionally, an aneurysm of the brachiocephalic trunk and multiple aneurysms of the right internal mammary artery were identified. Previous medical history included Loeys-Dietz syndrome (LDS) Type RII due to a TGF-beta receptor mutation, and beta thalassemia minor with a baseline hemoglobin of 9,3 g/dL on admission.Reconstruction of the aortic root and hemiarch replacement was performed in circulatory arrest under moderate hypothermia. During surgery, hypothermia was required as part of the cerebral protection strategy. We aim to highlight special considerations and discuss the effects of cooling, rewarming and the use of cardiopulmonary bypass (CPB) during extensive surgery in a patient with LDS and beta thalassemia minor.

Surgical or Percutaneous Repair of Sinus of Valsalva Rupture: Case Series and Literature Review.

The rupture of the sinus of the Valsalva aneurysm is a rare but very serious condition. Rapid and accurate diagnosis and prompt treatment are critical for these cases. We present two cases of sinus of Valsalva ruptures. One case was managed with open surgical repair and the second case was treated percutaneously. We have discussed these two therapeutic approaches available to treat sinus of Valsalva rupture.

Abstract 520: Stethoscope Still Saving Lives: Catching A Ruptured Sinus Of Valsalva Aneurysm

Introduction: Sinus of Valsalva aneurysm (SVA) is a rare cardiac abnormality that can occur congenitally or as a result of acquired conditions. It is characterized by a weakness in the elastic lamina at the junction of the aortic media and annulus fibrosis, leading to the formation of an SVA. We present an interesting case of a 54-year-old man, initially diagnosed with infective endocarditis and later on found to have a severe acute rupture of an SVA. Case Presentation: A 54-year-old man with a past medical history of raynaud's disease and rheumatoid arthritis presented with shortness of breath and low-grade fever for two weeks. On further evaluations, a diligent finding of a continuous cardiac murmur and a palpable thrill across the precordium led to a transthoracic echocardiogram (TTE). The TTE revealed a 1.3 x 1.3 cm, nonmobile, ball of material near the base of the septal leaflet of the tricuspid valve, raising concerns about infective endocarditis and thus initiation of broad-spectrum intravenous antibiotics. Subsequent transesophageal echocardiogram, however, revealed an outpouching from the right coronary sinus suggestive of the right sinus of Valsalva which was ruptured with jet hitting the tricuspid valve continuously during diastole and systole, mimicking falsely as vegetation on TTE. Emergency interventions including CT angiogram, catheterization, and surgical repair resulted in a favorable outcome for the patient. Discussion: SVA has a higher prevalence among males and individuals of Asian ethnicity. Its presentation is variable and can include chest discomfort, shortness of breath, pulmonary edema, or even rupture. It can also be an incidental finding on an echocardiogram. The preferred initial diagnostic approach is echocardiography, and surgical repair is often required for patients, especially if the aneurysm has ruptured. Upon diagnosis, prompt evaluation by a cardiothoracic surgeon is crucial as delay in treatment may lead to fatal consequences. Conclusion: The prognosis for ruptured SVAs is poor, which further emphasizes the significance of early diagnosis and prompt treatment. A diligent physical examination is very crucial and can be lifesaving, especially in such circumstances.

H Syndrome Presenting with Sinus of Valsalva Aneurysm and Possible Founder Mutation (p.Arg134cys) in Indian Patients.

H Syndrome Presenting with Sinus of Valsalva Aneurysm and Possible Founder Mutation (p.Arg134cys) in Indian Patients.

Ruptured sinus of Valsalva aneurysm: A Case Report

One of the rare cardiac anomaly is Sinus of Valsalva aneurysm (SVA) that can rupture spontaneously into other cardiac chambers or the pericardial space.1 Here, we report a rare case of a right coronary sinus of Valsalva aneurysm with rupture into the Left ventricular outflow tract (LVOT). Cardiovasc j 2023; 15(2): 182-184

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.

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.

An unpredictable gastrointestinal bleed.

A 65-year-old male complained of persistent melena for 6 days, and displayed anemia symptoms without hematemesis, vomiting, and abdominal distention. He was diagnosed as ruptured aneurysm of aortic sinus Valsalva, and had received coronary artery occlusion 1 month ago. After the operation, he was continually prescribed clopidogrel 75 mg once daily. The laboratory examination showed blood hemoglobin concentration was 60 g/L without other conspicuous abnormality. Unfortunately, neither esophagogastroduodenoscopy (EGD) nor colonoscopy found no obvious bleeding lesions. And abdominal computed tomography angiography (CTA) and enhanced computed tomography (CT) showed no obvious abnormal findings. Moreover, capsule endoscopy revealed small intestinal with mucosal erosion (Figure 1A). After discontinued clopidogrel, blood transfusion, and support therapy, his symptoms was resolved with negative fecal occult blood, continued clopidogrel 75 mg once daily, and uneventfully discharged 1 week later.

A simple and innovative repair of an incidentally discovered sinus of valsalva aneurysm during aortic valve replacement

A simple and innovative repair of an incidentally discovered sinus of valsalva aneurysm during aortic valve replacement

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.

A Rare Case Report of Ruptured Sinus of Valsalva Aneurysm

&lt;p&gt;主動脈竇動脈瘤是一種罕見的心臟結構病變，因具非特異性表徵及困難診斷，容易導致高死亡風險。本案例是一位53歲男性患者，因急性胸痛入院治療，藉由實驗室檢查發現心肌酵素升高、D-二聚體升高，心電圖檢查為aVR導程ST段上升、於第I、II、V4~6導程出現ST-T波段變化，初步診斷為左冠狀動脈主幹心肌梗塞，立即行冠狀動脈攝影檢查發現無異常。個案出現胸痛合併心因性休克之症狀，從中排除主動脈剝離、肺栓塞、心包填塞等診斷，深入檢視病史紀錄及影像報告，發現心臟超音波、胸部電腦斷層及冠狀動脈血管攝影檢查有由左流向右心室的瘻管分流，最終確診為主動脈竇動脈瘤破裂。患者緊急接受右冠狀竇動脈瘤修補及主動脈瓣置換手術治療後，胸痛、休克狀況改善且左心室功能恢復，術後預後良好。在面對急性胸痛合併血液動力學不穩定的患者時，除了須考慮症狀相關的疾病診斷外，當聽診發現S1及S2連續性心雜音時，建議將主動脈竇動脈瘤破裂列入考慮，以掌握治療處置之重要時機。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Aneurysm of the sinus of Valsalva is a rare cardiac anomaly due to the nonspecific symptoms and dif-ficult confirmation of diagnosis leading to high mortality. This report describes the case of a 53-year-old man who had suffered from acute chest pain. The electrocardiogram showed the ST segment ele-vation in lead aVR and ST-T wave changes in leads I, II and V4-6. Elevated D-dimer levels and cardi-ac enzymes were also observed. Acute myocardial infarction caused by the left main coronary artery obstruction was initial diagnosed. Coronary angiogram was performed immediately and the result indicated non-obstructive coronary artery. However, cardiogenic shock with persistent chest pain was discovered. Aortic dissection, pulmonary thromboembolism and cardiac tamponade were gradually excluded. Through detailed review and analysis of medical history, physical assessment and image ex-aminations with echocardiography, chest computed tomography and coronary angiogram, a ruptured sinus of Valsalva aneurysm was eventually diagnosed based on image examinations which revealed left-to-right shunt communicating with the right-sided heart chambers. The patient received emergen-cy right coronary sinus aneurysm repairment and aortic valve replacement surgery. Symptoms with chest pain and shock gradually disappeared and left ventricular function was restored postoperatively. The patient demonstrated excellent recovery. In facing relevance diagnostics for patients with acute chest pain and hemodynamic instability, a ruptured sinus of Valsalva aneurysm must be considered to endure best treatment timing if heart auscultation reveals S1 and S2 continuous murmurs.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

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 Reconstruction of Valsalva Sinus Aneurysms: One Surgical Team Outcomes from Tertiary Center

Background: There are many surgical methods used to treat sinus of Valsalva aneurysms, and these methods vary depending on the surgical team's expertise and the patient's health, which has an impact on the surgical outcomes. Objectives: In our study, we evaluated the midterm outcomes of a single center's highly skilled surgical team. Methods: In this retrospective cohort study the clinical data of 42 consecutive patients from November 1, 2005 to 21 august 2018 were reviewed and early and mid-term results were assessed. Twenty-two patients (53%) were presented with ruptured aneurysms; 8 of these patients (28.5%) had their aneurysms repaired with a double patch and an AV repair; nonetheless, 20 patients (46.6%) required valve replacement. Results: It was found that there was no bicuspid valve in our patients, no correlation between the presence of VSD and the severity of aortic insufficiency in our series (P = 0.89), and the severity of aortic insufficiency increased when the Valsalva aneurysm ruptured into the heart chambers. There was a strong association between female gender and ruptured sinus of Valsalva aneurysms (P = 0.02, AI severity, P = 0.05, aortic valve surgery, P = 0.03, and total AV replacement, P = 0.001). RSOV and the likelihood of a heart block did not correlate in our series (P = 0. 29). Conclusions: Results from one surgical team, particularly when the same specialist is making decisions, are more trustworthy. Excellent long-term outcomes are obtained, and rupture of the SOV is linked to an increase in AI and, ultimately, to aortic valve surgery, primarily AV replacement. Using patch technique for closing fistulas does not increase the post op arrhythmia.

Medium-term outcomes of a modified technique for RSOV-VSD subset.

Rupture of sinus of Valsalva (RSOV) aneurysm to right ventricular outflow tract or main pulmonary artery is commonly associated with subaortic ventricular septal defect (VSD). A standard surgical approach described is double patch closure. We have adopted the principle of transaortic direct closure of VSD with prosthetic patch closure of sinus defect; this novel technique is used for past 15years with good long-term results. We believe this technique appropriately addresses the embryo-pathological basis of RSOV-VSD complex.

Three-Dimensional Multimodality Image-Guided Transcatheter Device Closure of Ruptured Aortic Sinus of Valsalva Aneurysm.

HomeCirculation: Cardiovascular ImagingVol. 16, No. 3Three-Dimensional Multimodality Image-Guided Transcatheter Device Closure of Ruptured Aortic Sinus of Valsalva Aneurysm No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessCase ReportRequest AccessFull TextThree-Dimensional Multimodality Image-Guided Transcatheter Device Closure of Ruptured Aortic Sinus of Valsalva Aneurysm Sarah Pradhan, Shabana Shahanavaz and Justin T. Tretter Sarah PradhanSarah Pradhan Correspondence to: Sarah Pradhan, MD, Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229. Email E-mail Address: [email protected] https://orcid.org/0000-0002-9419-8278 Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH (S.P., S.S., J.T.T.). Search for more papers by this author , Shabana ShahanavazShabana Shahanavaz https://orcid.org/0000-0003-1620-9709 Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH (S.P., S.S., J.T.T.). Department of Pediatrics, University of Cincinnati College of Medicine, OH (S.S., J.T.T.). Search for more papers by this author and Justin T. TretterJustin T. Tretter https://orcid.org/0000-0001-8926-3752 Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH (S.P., S.S., J.T.T.). Department of Pediatrics, University of Cincinnati College of Medicine, OH (S.S., J.T.T.). Search for more papers by this author Originally published9 Nov 2022https://doi.org/10.1161/CIRCIMAGING.122.014361Circulation: Cardiovascular Imaging. 2023;16FootnotesSupplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.122.014361.For Sources of Funding and Disclosures, see page 303.Correspondence to: Sarah Pradhan, MD, Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229. Email sarah.[email protected]com

Abstract 14581: Massive Sinus of Valsalva Aneurysm With Rupture Into the Right Atrium

Case Presentation: A 40-year-old male presented with decompensated heart failure and severe pulmonary hypertension (echo-predicted right ventricular systolic pressure 60 mmHg). Right heart catheterization revealed high output heart failure (cardiac index 7.3 L/min/m 2 ), left to right shunt (Qp:Qs 3.6:1), pulmonary hypertension (mean 38 mmHg), and normal pulmonary resistance (1.53 Wood units). Transesophageal echocardiogram revealed a large non-coronary sinus of Valsalva aneurysm with communication to the right atrium (Figure 1a and b). Percutaneous transcatheter closure of the aneurysm was deferred due to large size (3.3 x 4.3 cm), proximity to the right coronary artery, and risk of aneurysm rupture with catheter manipulation (Figure 1c). The patient underwent surgical aneurysm resection and aortic root replacement and recovered well. Discussion: Sinus of Valsalva aneurysms (SVAs) are rare pathologies characterized by expansion of the aortic root wall between the sinotubular junction and the aortic valve annulus and are often associated with connective tissue disorders. SVAs are often diagnosed incidentally on imaging but can present with symptoms if they rupture into nearby cardiac structures, such as an aorto-atrial fistula with left to right shunting, high output heart failure and hemodynamic compromise, as in this case. While transthoracic echocardiogram is the diagnostic modality of choice for most SVAs, multimodality imaging, catheterization, and advanced imaging may also be needed. Surgical repair remains the gold standard of therapy, however treatment with transcatheter device placement has also been successfully performed.

Ruptured Valsalva aneurysm of the non-coronary cusp: a case report

Ruptured Valsalva aneurysm of the non-coronary cusp: a case report

Sinus of Valsalva aneurysm: Defining the optimal approach.

Sinus of Valsalva aneurysm (SVA) is relatively rare, especially in Western countries, and reports on long-term results after surgical SVA repair in a sizable patient cohort are scarce. In this issue of the Journal of Cardiac Surgery, Chaganti and colleagues publish their surgical experience over the past 30 years in 216 patients with SVA.SVAs were closed via a dual approach, with (1) patch closure (80%) or direct closure (20%) of the base of the fistula through aortotomy and (2) direct closure of the ruptured tip through the chamber of rupture. Aortic valve replacement (9.7%) or repair (6.5%) was performed for moderate to severe aortic regurgitation (AR). There was no hospital mortality. During a mean follow-up of 10 years, no patient had residual/recurrent shunting. The actual survival at 10 years was 99%, with only two deaths. Freedom from moderate or severe AR was 98.5% at 10 years. Early and long-term results after surgical repair of SVA were excellent in their 216 patients with a mean follow-up of 10 years. Their dual approach for SVA was effective in preventing residual/recurrent shunting. The need for AVR in 10% of the patients speaks to the importance of follow-up. The current report provides strong support for surgical repair being the preferred management for SVA.

Sinus of valsalva aneurysm: A single institutional experience with 216 patients over 30 years.

Sinus of valsalva aneurysm (SVA) with rupture is a rare cardiac anomaly which can be congenital or acquired with reported incidence of 0.46%-3.57% among Asians population. The aim of this study is to analyze 30 years of single institutional surgical experience in management of 216 cases with SVAs from 1992 till date. Age group was from 6 to 64 years (mean: 32.5 ± 11 years) with male to female ratio of 2.2:1. The aneurysms originated from right coronary sinus in 181 cases (83.79%), noncoronary sinus in 35 cases (15.74%) and ruptured into the right ventricle in 149 cases (68.98%), right atrium in 59 cases (27.31%). Bicameral approach was used in majority of the cases (n = 213, 98.61%). Aneurysms were repaired using Dacron patch in 173 cases (80.09%) and direct closure in 43 cases (19.9%). Associated ventricular septal defect was closed with Dacron patch in 123 cases (56.94%). Aortic valve was replaced in 21 cases (9.72%) and aortic valve repair was performed in 14 cases (6.48%) for associated Aortic regurgitation. There were no perioperative hospital deaths. Follow-up was available in 204 patients (94.44%) ranging from 2 to 26 years (mean: 10 ± 5.6 years). Two deaths (0.92%) occurred during the postoperative follow-up period. The actual survival was 99.5% at 1 year, 99% at 5 and 10 years. Long term results of surgically repaired SVAs are good with low morbidity (3.24%) and mortality (0.92%) even when associated with major cardiac anomalies. Aortic valve repair and replacement both are equally feasible alternatives for management of moderate to severe aortic regurgitation with associated merits and demerits.

Percutaneous Closure of Ruptured Sinus of Valsalva Aneurysm

Ruptured sinus of Valsalva (RSOV) aneurysm is a rare but well-known entity. It is a form of left-to-right shunt due to the rupture of aortic sinus into cardiac chambers, more commonly right sided. Hemodynamic effects are acute and severe. Surgical repair of RSOV aneurysm is an established treatment option and is being done with excellent results. Over the last two decades, there are case reports and case seriers describing percutaneous closure of RSOV aneurysm with promising results. Before planning percutaneous closure of RSOV aneurysm, it is imperative to know the detailed anatomy of the defect and its hemodynamic effects and to rule out associated defects requiring surgical intervention. Echocardiography plays a crucial role in defining the lesion in detail and helps in decision-making.