1
|
Moguillansky N, Bleiweis M, Reid J, Jacobs JP, Moguillansky D. Ruptured Sinus of Valsalva Aneurysm: Three Case Reports and Literature Review. Cureus 2024; 16:e59220. [PMID: 38813300 PMCID: PMC11135838 DOI: 10.7759/cureus.59220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
Sinus of Valsalva aneurysm rupture (SOVAR) into the right cardiac chambers is an uncommon complication with unusual presentation, high morbidity and mortality, and unique hemodynamics as well as cardiac imaging findings. Here, we present three SOVAR cases (two with rupture into the right atrium and one with rupture into the right ventricle) that were initially confused for ventricular septal defects and describe their initial presentation, cardiac imaging studies, invasive hemodynamics, as well as treatment options. Some of the unique findings of SOVAR patients include an acute presentation, often with hemodynamic decompensation, the presence of a continuous murmur on examination, and also hemodynamics that include wide pulse pressure and right heart volume overload.
Collapse
Affiliation(s)
- Natalia Moguillansky
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, University of Florida Health, Gainesville, USA
| | - Mark Bleiweis
- Department of Pediatrics, Cardiology, Congenital Heart Center, University of Florida Health, Gainesville, USA
| | - Jana Reid
- Department of Cardiology, Congenital Heart Center, University of Florida Health, Gainesville, USA
| | - Jeffrey P Jacobs
- Department of Cardiology, Congenital Heart Center, University of Florida Health, Gainesville, USA
| | - Diego Moguillansky
- Department of Pediatrics, Cardiovascular Medicine and Internal Medicine, Congenital Heart Center, University of Florida Health, Gainesville, USA
| |
Collapse
|
2
|
Carrel T. Sinus of Valsalva Aneurysm: Different Modes of Presentation and Techniques of Repair. J Cardiovasc Dev Dis 2024; 11:100. [PMID: 38667718 PMCID: PMC11049840 DOI: 10.3390/jcdd11040100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
A sinus of valsalva aneurysm (SVA) is an asymmetrical dilatation of the aortic root located between the aortic valve anulus and the sino-tubular junction. Congenital weakness of the elastic lamina in the aortic media layer or trauma and infection as acquired events are the most principal causes of SVA. Presentation may be acute when rupture has occurred or SVA may be discovered fortuitously on echocardiography or CT scan when patients are examined because of unspecific chest pains, dyspnea or arrhythmias. Although endovascular treatment has been performed successfully in individual cases, surgical closure of the aneurysm aiming at preservation of the aortic valve whenever possible is the established procedure. This short report emphasizes the fact that individual treatment is required when SVA need to be operated, depending on the presentation, the location and the size of the finding. Surgery may consist of simple patch closure, bilateral tunnel closure (entry and exit) or more radical operation like Bentall in case the whole aortic root should be addressed. Overall results are excellent, independently of the clinical presentation (acute or elective) with a mortality approaching zero.
Collapse
Affiliation(s)
- Thierry Carrel
- Department of Cardiac Surgery, University Hospital Basel, CH-4032 Basel, Switzerland
| |
Collapse
|
3
|
Kassab K, Jolly N, Vij A, Kattoor AJ. Percutaneous closure of ruptured sinus of Valsalva: A review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 60:91-94. [PMID: 37777419 DOI: 10.1016/j.carrev.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/09/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Kameel Kassab
- Division of Cardiology, Yuma Regional Medical Center, Yuma, AZ, USA.
| | - Neeraj Jolly
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Aviral Vij
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA; Division of Cardiology, Cook County Health, Chicago, IL, USA
| | | |
Collapse
|
4
|
Ayati A, Toofaninejad N, Hosseinsabet A, Mohammadi F, Hosseini K. Transcatheter closure of a ruptured sinus of valsalva: a systematic review of the literature. Front Cardiovasc Med 2023; 10:1227761. [PMID: 37727309 PMCID: PMC10505828 DOI: 10.3389/fcvm.2023.1227761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023] Open
Abstract
Background Ruptured sinus of Valsalva (RSOV) is a rare pathology, and current data regarding its symptoms, anatomy, associated pathologies, and appropriate therapeutic approaches are scarce. Transcatheter closure (TCC) has been performed in multiple cases; however, the information on its success rate and complications is limited. Methods Two independent reviewers performed an advanced search based on inclusion criteria on Scopus, PubMed, and Embase from January 1985 through July 2022. The main search terms were "Sinus of Valsalva", "Rupture/Aneurysm", and "Transcatheter/Catheter/Device". Results Totally, 1,017 relevant articles from the 3 databases were retrieved. After the final review and appraisal, 94 articles describing 407 patients who underwent the TCC of RSOV were included. Males comprised 65% of the studied patients, and the average age was 34.5 years. The total success rate of TCC was 95.6%. Forty-nine patients (12%) developed complications, the most significant of which were sustained residual shunts in 7 patients (1.7%), substantial new onset or progression of aortic insufficiency in 6 (1.5%), and RSOV recurrence in 6 (1.5%). Post-interventional mortality was reported in only 2 patients (0.5%). Conclusions The present study is the first systematic review of available data regarding the TCC of RSOV principally comprising case series and case reports. Although TCC seems a good option, precise patient selection is mandatory.
Collapse
|
5
|
Suchodolski A, Głowacki J, Szulik M. Subtle symptoms, massive lesion in computed tomography: giant aneurysm of the right sinus of Valsalva. Coron Artery Dis 2023; 34:223-224. [PMID: 36951748 DOI: 10.1097/mca.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- Alexander Suchodolski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia
| | - Jan Głowacki
- Department of Radiology and Radiodiagnostics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice
- Computed Tomography Laboratory, Silesian Centre for Heart Diseases, Zabrze
| | - Mariola Szulik
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia
- Department of Medical and Health Sciences, WSB University Faculty of Applied Sciences, Dąbrowa Górnicza, Poland
| |
Collapse
|
6
|
Köse Y, Özyurt Köse S, Koçoğulları CU. Dilated sinuses of Valsalva subsequent to type A dissection surgery: Is reoperation inevitable? TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:171-175. [PMID: 37484642 PMCID: PMC10357858 DOI: 10.5606/tgkdc.dergisi.2023.24330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/05/2023] [Indexed: 07/25/2023]
Abstract
Background This study aims to investigate the dilation of sinus valsalva in patients who underwent aortic repair due to type A aortic dissection and to evaluate its progression. Methods Between January 2004 and December 2019, a total of 68 patients (50 males, 18 females; mean age: 54.2±10.1 years; range, 30 to 82 years) who underwent root-preserving surgery and followed for at least one year in the outpatient setting were retrospectively analyzed. The patients were divided into two groups according to dilatation during follow-up. Group 1 (n=32) included patients with dilatation and Group 2 (n=36) included patients without dilatation. The sinus of Valsalva diameters were measured using pre- and postoperative computed tomography angiography. Results The mean follow-up was 4.9±3.1 (range, 1 to 4) years. Sinus of Valsalva dilatation was observed in 47% of the patients during follow-up. Preoperative sinus of Valsalva diameter was a risk factor for aneurysmatic dilatation. A diameter of ≥4.05 cm was calculated as a cut-off value for developing dilatation requiring reoperation. Conclusion Follow-up using postoperative echocardiography or computed tomography angiography is of utmost importance for the assessment of development of sinus of Valsalva dilatation which requires reoperation in patients without intervention to the aortic root.
Collapse
Affiliation(s)
- Yiğit Köse
- Department of Cardiovascular Surgery, Health Sciences University, Dr. Siyami Ersek Chest Heart and Vascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Selen Özyurt Köse
- Department of Neurology, Marmara University Pendik Training and Research Hospital, Istanbul, Türkiye
| | - Cevdet Uğur Koçoğulları
- Department of Cardiovascular Surgery, Health Sciences University, Dr. Siyami Ersek Chest Heart and Vascular Surgery Training and Research Hospital, Istanbul, Türkiye
| |
Collapse
|
7
|
Ayati A, Toofaninejad N, Hosseinsabet A, Hosseini K, Hajizeinali A. Transcatheter closure of ruptured sinus of Valsalva: A report of first five cases in Tehran Heart Center, Iran. Clin Case Rep 2023; 11:e7036. [PMID: 36895508 PMCID: PMC9989363 DOI: 10.1002/ccr3.7036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/08/2023] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
Ruptured sinus of Valsalva (RSOV) is a potentially lethal lesion requiring prompt intervention. Transcatheter Closure of RSOV is a novel alternative to the standard treatment, which is open-heart surgery. In this case series, we have reported our center's first five cases of RSOV patients undergoing Transcatheter Closure.
Collapse
Affiliation(s)
- Aryan Ayati
- Cardiology Department, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Neda Toofaninejad
- Cardiology Department, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Kaveh Hosseini
- Cardiology Department, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | | |
Collapse
|
8
|
Krasemann T, Dalinghaus M, van den Berg G, Rebel B. Interventional Closure of a Ruptured Sinus of Valsalva with a Konar-Multifunctional Device. AORTA (STAMFORD, CONN.) 2022; 10:259-262. [PMID: 36539120 PMCID: PMC9767771 DOI: 10.1055/s-0042-1750411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 14-year-old girl with trisomy 13 presented with signs of respiratory failure. This was caused by the rupture of a sinus of Valsalva aneurysm into the right atrium. A Konar Multifunctional Occluder was used for closure. This is the first report of this device for this indication.
Collapse
Affiliation(s)
- Thomas Krasemann
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands,Address for correspondence Thomas Krasemann, MD(D) Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Centre RotterdamWytemaweg 80, 3015CN RotterdamThe Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
| | - Gert van den Berg
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
| | - Bas Rebel
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
9
|
Transcatheter Versus Surgical Closure of Acute Ruptured Sinus of Valsalva Aneurysms with Associated Ventricular Septal Defects. Pediatr Cardiol 2022; 43:1494-1501. [PMID: 35380217 DOI: 10.1007/s00246-022-02873-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Transcatheter ruptured sinus of valsalva aneurysm (RSOVA) closure is an alternative to surgery. When a restrictive ventricular septal defect (rVSD) coexists, there are doubts about support for an occluder and persistent left ventricular (LV) dilatation. We compared the outcomes of patients from a single centre with rVSD and RSOVA after surgery or transcatheter intervention in the past 8 years in this study. Location of rVSD did not alter the approach. Compliant balloon interrogation before transcatheter closure was occasionally used to assess significance of interventricular shunt or aortic regurgitation. Procedural success and LV dimensions before and after treatment were analyzed. Seventeen patients with a mean age of 36.64 ± 12.58 years were analyzed. 12/13 catheter procedures (92%) were successful, of whom eight patients had an outlet VSD. rVSD was closed with device in one patient with perimembranous rVSD, but unaddressed in others. Four patients underwent balloon interrogation. Surgery included the single patient who failed intervention. Transcatheter group had more acute symptoms and advanced functional class than surgical group, though not significant. At a median follow-up of 4.5 (1-7.5) years, the mean LV dimensions (50.3 ± 10.1 mm and 50.1 ± 3.1 mm, p = 0.46) were not different in the transcatheter and surgical groups. Mean end-diastolic volumes (110.5 ± 42. 1 ml and 98.5 ± 37.5 ml, p = 0.91) were not significantly different either. Transcatheter RSOVA closure success was not altered by rVSD despite their location underneath the aneurysms, including outlet rVSD with defect in aortoventricular junction. Persistent LV dilatation was not observed after catheter intervention even when the VSD was not closed.
Collapse
|
10
|
Zhou R, Yeung M, Sharma MS. Multimodality delineation of a fistulous ruptured sinus of Valsalva aneurysm: a teaching case report. Eur Heart J Case Rep 2022; 6:ytac308. [PMID: 35949703 PMCID: PMC9356725 DOI: 10.1093/ehjcr/ytac308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/08/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Ruptured sinus of Valsalva (SOV) is a rare cardiac anomaly with poor prognosis if untreated. Early diagnosis with accurate delineation of its anatomy is critical for timely treatment and choice of surgical vs. percutaneous intervention. Here we report a case of fistulous rupture of SOV; the preoperative multimodality studies including echocardiography, cardiac magnetic resonance and cardiac catheterization provided teaching and learning points.
Case summary
A 48-year-old man with history of heart murmur and hypertension presented with a 5-day history of shortness of breath and peripheral oedema. He was diagnosed with rapid atrial flutter. The transthoracic and transesophageal echocardiography showed severe biventricular systolic dysfunction with a left-to-right shunt from ruptured SOV. The colour Doppler by transthoracic and transesophageal echocardiography and cardiac magnetic resonance revealed a swaying shunt flow exiting in direction to the right atrium (RA) and basal right ventricle (RV) during systole and diastole with no myocardial scaring. The left and right heart catheterization showed elevated right-sided pressures, pulmonary capillary wedge pressure, and left ventricular end-diastolic pressure. There was no difference in O2 saturation between venae cavae and RA but a misleading step-up in O2 saturation between RA and RV. Owing to rupture anatomy with uncertainty, the patient underwent surgical intervention. The ruptured SOV tunnelled through the base of tricuspid annulus to the RA very close to the basal RV.
Discussion
Even with multimodality studies it can still be challenging to delineate the anatomy of a ruptured SOV without uncertainty preoperatively.
Collapse
Affiliation(s)
- Ruihai Zhou
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, NC 27599-7075 , USA
| | - Michael Yeung
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, NC 27599-7075 , USA
| | - Mahesh S Sharma
- Department of Cardiothoracic Surgery, University of North Carolina at Chapel Hill , Chapel Hill, NC 27599-7075 , USA
| |
Collapse
|
11
|
An Up-to-Date Narrative Review on Congenital Heart Disease Percutaneous Treatment in Children Using Contemporary Devices. Diagnostics (Basel) 2022; 12:diagnostics12051189. [PMID: 35626343 PMCID: PMC9139868 DOI: 10.3390/diagnostics12051189] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Congenital heart pathology has a significant burden regarding morbidity and mortality in the pediatric population. Several transcatheter interventions and devices have been designed as an alternative to surgical repair. Percutaneous interventions have been proven to yield good results in most cases but with less stress and trauma than that attributed to surgical treatment, especially in frail pediatric patients. We aimed to review the literature and to investigate the feasibility and efficacy of transcatheter interventions and implantable devices for congenital heart disease management in children. Methods: We performed a search in Scopus and MEDLINE databases using prespecified keywords to retrieve clinical studies published between 2000 and 2021. Results: This article provides an up-to-date review regarding the applicability of interventional techniques in simple inter-atrial or inter-ventricular defects, and in challenging congenital defects, such as hypoplastic left heart syndrome, tetralogy of Fallot, or coronary artery fistula. Furthermore, we reviewed recent indications for defibrillator and cardiac resynchronization therapy, and new and promising devices currently being tested. Conclusion: Transcatheter treatment represents a feasible and efficient alternative to surgical repair of congenital heart defects. Novel devices could extend the indications and possibilities of percutaneous interventions in pediatric patients with congenital heart diseases.
Collapse
|
12
|
Sabiniewicz A, Lubocka P, Sabiniewicz R. Case Report: Right Heart Failure Mistaken for Obesity-A Fault of Telemedicine. Front Pediatr 2022; 10:856911. [PMID: 35547550 PMCID: PMC9083262 DOI: 10.3389/fped.2022.856911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
As a result of the COVID-19 pandemic, telemedicine has become an important branch of healthcare worldwide. Apart from their undeniable advantages, the virtual visits lack physical examination, which can lead to important diagnostic mistakes. We hereby present a case of a pediatric patient whose weight gain, initially attributed to a sedentary lifestyle was, in fact, due to sub-acute right heart failure in the context of a ruptured sinus of Valsalva aneurysm. The condition was not diagnosed until the patient presented at the emergency. The boy was successfully treated with two percutaneous interventions and returned to his previous stature.
Collapse
Affiliation(s)
| | - Paulina Lubocka
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdansk, Poland
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdansk, Poland
| |
Collapse
|
13
|
Ramani Devi T, Chenniappan M, Jothi N. Successful Outcome of Pregnancy in a Case of Rupture of Sinus of Valsalva Aneurysm: An Interdisciplinary Case Report. J Obstet Gynaecol India 2021; 71:440-444. [PMID: 34566306 DOI: 10.1007/s13224-021-01452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022] Open
Affiliation(s)
- T Ramani Devi
- Ramakrishna Medical Centre LLP, 20, 21, Vivekananda Nagar, Woraiyur, Trichy, Tamil Nadu 620003 India
| | - M Chenniappan
- Ramakrishna Medical Centre LLP, 20, 21, Vivekananda Nagar, Woraiyur, Trichy, Tamil Nadu 620003 India
| | - N Jothi
- Ramakrishna Medical Centre LLP, 20, 21, Vivekananda Nagar, Woraiyur, Trichy, Tamil Nadu 620003 India
| |
Collapse
|
14
|
Matta A, Nagabandi AK, Bande D. A Short Case Report on Ruptured Sinus of Valsalva Aneurysm. Cureus 2020; 12:e10263. [PMID: 33042701 PMCID: PMC7537488 DOI: 10.7759/cureus.10263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 35-year-old woman without any history of congenital heart disease presented to our clinic with dyspnea on exertion. Transthoracic echocardiogram (TTE) showed an eccentric tricuspid regurgitant jet and increased right ventricular systolic pressure. Transesophageal echocardiogram (TEE) revealed a sinus of Valsalva aneurysm (SVA) arising from the noncoronary sinus that ruptured into the right atrium, leading to the formation of an aorto-right atrial fistula. Right heart catheterization confirmed left to right shunt. The fistulous tract was resected, and the aneurysm repaired surgically. The patient made a good recovery.
Collapse
|
15
|
Transcatheter closure of a chronic post-traumatic aorto-right ventricular fistula. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|