Surgical Repair of Postoperative Left Sinus of Valsalva Aneurysm Dissecting Into the Interventricular Septum

Transcatheter closure of ruptured sinus of Valsalva type IV with misleading severe aortic regurgitation

We present an unusual case of ruptured sinus of Valsalva (RSOV) in the right atrium, progressive exertional dyspnea, occasional epigastric heaviness, and palpitations. The examination revealed high-pitch continuous murmur. On transthoracic echocardiography, there was a ~5-6 mm size RSOV of non-coronary sinus into right atrium, continuous turbulent flow, and unusual presentation of severe central aortic regurgitation jet with holodiastolic flow reversal seen in the descending aorta. The sinus of Valsalva aneurysm is a rare pathology, which is generally asymptomatic. In this case it manifested through a rupture into the right atrium and needed to be closed to relieve the symptoms. Transcathter closure of RSOV was done by using Amplatzer duct occluding device, there was no residual shunt, and aortic regurgitation completely disappeared.

Learning objective

This is a unique case in which ruptured sinus of Valsalva flow and holodiastolic flow reversal were confused with severe aortic regurgitation. Careful and detailed transthoracic echocardiography played a key role in correct diagnosis and proper management.

Aneurysms of Aortic Sinus of Valsalva Dissecting through the Interventricular Septum With Rupture into the Left Ventricle: Case Series and Literature Review

Aneurysm of Aortic sinus of Valsalva (ASOV) dissecting into the interventricular septum (IVS) and rupturing into the left ventricle (LV) is a rare clinical diagnosis. Systemic inflammatory diseases like tuberculosis can aggravate this condition. We describe three cases of ASOV dissecting into the IVS and rupturing into the LV. All three patients underwent surgical intervention; two had a successful outcome. A literature review was conducted and19 previously reported cases were studied. The extent and direction of septal dissection determined the associated cardiac valvular and rhythm problems. Patch closure of the mouth of the aneurysm is the surgical method of choice. In the presence of multiple sinus tracts or if there is recurrence after surgical closure, aortic sinus or root replacement techniques have better outcomes.

Aneurysm of the sinus of Valsalva dissecting into the intraventricular septum

Aneurysm of the sinus of Valsalva is an uncommon entity and especially rare when it dissects into the intraventricular septum. This uncommon clinical manifestation often takes a drastic clinical course with life-threatening arrhythmia, coronary ischemia, rupture, and heart failure. We present the case of a 36-year-old man with an aneurysm of the sinus of Valsalva dissecting into the intraventricular septum, which induced severe aortic insufficiency and heart block.

Aneurysm of sinus of Valsalva: uncommon presentation

A 28-year-old man presented with acute onset of chest pain. Transthoracic echocardiography confirmed an aneurysm of the sinus of Valsalva dissecting into the interventricular septum. During the next 12 h, the aneurysm enlarged to involve the entire interventricular septum, and the patient developed features of cardiac tamponade. He underwent successful surgical repair.

Aneurysm of sinus of valsalva dissecting into the interventricular septum after aortic valve replacement: diagnosis by echocardiography and magnetic resonance imaging and treatment with surgical sealant

Aneurysm of the sinus of Valsalva that causes dissection of the interventricular septum is an extremely rare entity. In this report we describe a case of aneurysm of the sinus of Valsalva dissecting into the interventricular septum, from the base to mid septum, after aortic valve replacement. After the diagnosis was made by transthoracic echocardiography and magnetic resonance imaging, the patient was successfully treated with surgical sealant-mediated occlusion of the aneurysmal sac and cardiac resynchronization therapy used for the first time.

Sinus of Valsalva aneurysm--an unusual cause of syncope

Sinus of Valsalva aneurysms (SOVA) are rare anomalies which often only become apparent at the time of rupture. Syncope associated with unruptured aneurysms is a recognized symptom but in most previously reported cases the mechanism has been either a brady- or tachyarrhythmia. We report a case of a large SOVA affecting the right coronary cusp which presented with syncope secondary to hypotension thought to be resulting from reduced left atrial filling as a consequence of transient right ventricular outflow tract (RVOT) obstruction. The case demonstrates how echocardiographic and angiographic images correlate and also an unusual mechanism of syncope. SOVA are rare anomalies that often only become apparent at the time of rupture. Syncope associated with unruptured aneurysms is a recognized symptom but in most previously reported cases the mechanism has been either a brady- or tachyarrhythmia. We report a case of a large SOVA affecting the right coronary cusp, which presented with syncope secondary to hypotension thought to be resulting from reduced left atrial filling as a consequence of transient RVOT obstruction. The case demonstrates how echocardiographic and angiographic images correlate and also an unusual mechanism of syncope.

Surgery for Sinus of Valsalva Aneurysm: 27-Year Experience with 100 Patients

Sinus of Valsalva aneurysm is a rare anomaly. This study was designed to assess the long-term outcome of surgical repair of sinus of Valsalva aneurysm and factors influencing the prognosis. From August 1980 to August sinus of Valsalva aneurysm repair. Ventricular septal defect (42) and aortic regurgitation (34) were the most frequent coexisting anomalies. An approach via the involved chamber was used in 60 patients, aortotomy in 5, and a combined approach in 35. Either direct (43) or patch (57) closure was used to repair the defect. Aortic valve replacement was required in 14 patients, and 8 needed valvuloplasty. Eighty patients were followed up for 15.6 ± 3.9 years. There were 3 hospital deaths and 2 late deaths. New York Heart Association functional class improved significantly after surgery. Actuarial survival was 94% at 10 years, and 90% at 15 years. Surgical treatment of sinus of Valsalva aneurysm is safe and effective, but late progressive aortic regurgitation is still a risk during long-term follow-up, and early aggressive measures are recommended.

Acute myocardial infarction due to an unruptured sinus of Valsalva aneurysm in a patient with Behçet's syndrome

This report describes the case of a 45-year-old Korean female who had suffered from Behçet's syndrome for two years with a huge, unruptured aneurysm originating from the left coronary sinus. The aneurysm had caused myocardial and aortic insufficiency by compressing the proximal left anterior descending coronary artery. The orifice of the aneurysm was at the left coronary sinus, about 5 mm from the left main coronary ostium, and it was filled with organized thrombi. Surgical repair was performed by closing the entrance of the aneurysm with a Dacron patch and by implementing aortic valve repair and coronary artery bypass grafting. The patient's coronary flow was restored postoperatively, and all anginal symptoms disappeared.