Ruptured congenital aneurysm of the sinus of Valsalva with persistent left superior vena cava imaged by intraoperative transesophageal echocardiography

Thrombosed sinus of Valsalva aneurysm masquer ading as a cardiac tumour: a case report

Background

An aortic sinus of Valsalva aneurysm (SVA) often remains undiagnosed until it ruptures. An SVA filled with thrombus can be challenging to diagnose accurately.

Case summary

A 70-year-old man was admitted with a clinical diagnosis of well-tolerated complete atrioventricular block (AVB). Transthoracic echocardiography revealed a spherical mass (43 × 49 mm) at the interatrial septum. Enhanced computed tomography (CT) showed a well-defined, hollow, and non-enhanced mass suggesting a cardiac tumour. However, 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) showed no uptake in the mass. After implantation of a permanent pacemaker, anticoagulant therapy was started for paroxysmal atrial fibrillation. Two months later, follow-up evaluation by echocardiography and enhanced CT revealed an increase in size of the hollow interior cavity, suggesting thrombolysis by the anticoagulant. We diagnosed a non-coronary SVA filled with thrombus, which masqueraded as a cardiac tumour and may have caused complete AVB.

Conclusions

We describe a rare case of a giant thrombosed SVA masquerading as a cardiac tumour. Initial 18F-FDG PET/CT and serial imaging studies were helpful in distinguishing it from a cardiac tumour.

Valsalva aneurysm filled with thrombi mimicking a cardiac tumor

A Valsalva aneurysm filled with thrombi can be difficult to diagnose, because it mimics a cardiac tumor. Both cardiac magnetic resonance imaging (MRI) and transesophageal echocardiogram (TEE) were performed on a patient who showed a low-echoic mass located between the atrial septum and the non-coronary sinus. Based on MRI findings allowing tissue characterization and the accurate location of the mass and the TEE findings of an irregular surface of the mass and a partial defect in the edge of the non-coronary sinus, we diagnosed the mass as a thrombosed Valsalva aneurysm that had perforated the inter-atrial septum. The operative findings coincided with the preoperative diagnosis. Both MRI and TEE are useful for diagnosing this condition.

An Unusual Cause of Pulmonary Edema: Acute Rupture of Noncoronary Sinus of Valsalva Aneurysm into the Left Atrium

We present the case of a patient admitted to hospital with pulmonary edema and atrial fibrillation. The transthoracic echocardiogram showed noncoronary sinus of Valsalva aneurysm ruptured into the left atrium, with a turbulent flow directed toward the left atrium floor and the pulmonary vein, which explained the clinical presentation. Echocardiography played a crucial role in identification of the cause and correct therapeutic approach.

[Multiplane transesophageal echocardiography in the preoperative evaluation of the sinus of Valsalva fistula to right chambers]

INTRODUCTION AND OBJECTIVES

Ruptured sinus of Valsalva aneurysm to right cardiac chambers is an uncommon lesion in Western countries. The prognosis is usually serious unless the condition is promptly treated surgically. For this reason an accurate anatomical and functional evaluation is necessary. The main purpose of this report is to compare the usefulness of multiplane transesophageal echocardiography with transthoracic echocardiography and angiocardiography in the preoperative evaluation of ruptured sinus of Valsalva aneurysm to right chambers.

PATIENTS AND METHOD

Since January 1990, 9 patients (mean age 36,3 18 yr, 6 males) with ruptured sinus of Valsalva aneurysm to right chambers were studied. The pathogenesis was congenital aneurysm in 6 patients, aortic prosthesis endocarditis in one and two cases of iatrogenia: during a percutaneous mitral valvuloplasty and after cardiac surgery. Transthoracic echocardiography was performed in all cases, transesophageal echocardiography in 7 and angiocardiography in 8. Two patients died before surgery, and 7 were successfully operated on.

RESULTS

Transesophageal echocardiography was more useful when compared to transthoracic echocardiography and angiocardiography in detecting: a) the fistula; b) the sinus involved; c) the right chamber affected; d) congenital aneurysms morphology and size; e) aneurysm prolapse through a ventricular septal defect, y f) the identification of other cardiac congenital or acquired anomalies.

CONCLUSIONS

Multiplane TEE is the most accurate tool in the preoperative evaluation of ruptured sinus of Valsalva aneurysm to right chambers.

Imaging of an aneurysm of the sinus of Valsalva with transesophageal echocardiography, contrast angiography and MRI

A sinus of Valsalva aneurysm is an uncommon congenital defect, which requires appropriate diagnosis with either echocardiography, magnetic resonance imaging or contrast angiography. Treatment consists of aortic valve repair. We describe a young woman with an aneurysm of the non-coronary sinus of Valsalva, an atrial septal defect and pulmonary insufficiency. The different imaging techniques and possibilities of surgical correction are described.

Ruptured aneurysm of the sinus of Valsalva in association with persistent left superior vena cava--a case report

A 58-year-old man presenting with chest pain and dyspnea was diagnosed by transesophageal echocardiography and cardiac catheterization to have the rare combination of ruptured aneurysm of noncoronary sinus of Valsalva into the right ventricle in association with persistent left superior vena cava. These defects were confirmed at cardiac surgery. This case shows the importance of complementary use of invasive and noninvasive methods together in the diagnosis of rare combinations of lesions.

Aneurysms in the left ventricular outflow tract: clinical presentation, causes, and echocardiographic features

We present a descriptive compendium of anatomically interrelated aneurysms and aneurysmal-like structures arising in and around the left ventricular outflow tract. Images selected from the Mayo Clinic echocardiography database illustrate classic or typical examples of each entity. Essential morphologic features of each lesion are described. Clinical presentation, causes, and diagnostic echocardiographic features taken together can improve recognition and clinical management of this diverse group of anomalies.

Doppler echocardiographic characteristics of sinus of valsalva aneurysms

This study evaluated the efficacy of a comprehensive transthoracic Doppler echocardiographic examination for correct detection of SVA and its associated lesions of VSD and aortic insufficiency. A consecutive series of 36 patients was obtained; all had surgical confirmation of the anatomic defects. The location of the SVA was correctly determined in 97% of patients, and the associated presence of a VSD was correctly determined in 79% of the studies. In the cases in which Doppler was available, all 11 patients with associated aortic insufficiency were detected. In this series 32 patients had right SVA, 3 had noncoronary sinus SVA, and 1 had a left SVA. Relative frequency of the rupture site location corresponded closely to that in previous necropsy studies. It is concluded that transthoracic Doppler echocardiography can correctly localize SVAs and most associated lesions.