Sinus of Valsalva aneurysm associated with multiple conotruncal congenital malformations

New Concepts in the Development and Malformation of the Arterial Valves

Although in many ways the arterial and atrioventricular valves are similar, both being derived for the most part from endocardial cushions, we now know that the arterial valves and their surrounding structures are uniquely dependent on progenitors from both the second heart field (SHF) and neural crest cells (NCC). Here, we will review aspects of arterial valve development, highlighting how our appreciation of NCC and the discovery of the SHF have altered our developmental models. We will highlight areas of research that have been particularly instructive for understanding how the leaflets form and remodel, as well as those with limited or conflicting results. With this background, we will explore how this developmental knowledge can help us to understand human valve malformations, particularly those of the bicuspid aortic valve (BAV). Controversies and the current state of valve genomics will be indicated.

An Unusual Case of Sinus of Valsalva Aneurysm in a GUCH Patient: An Unusual Side of the Aorto-Cardiac Fistula

Sinus of Valsalva aneurysm can be congenital or acquired. The major complication is rupture: this can represent an evolution or an abrupt event. In case of rupture or of large aneurysm, a surgical approach is justified. We report a case of ruptured sinus of Valsalva aneurysm in a seventeen years old girl, who had underwent surgical correction of Fallot tetralogy. As soon as the rupture of sinus of Valsalva aneurysm is suspected, echocardiographic examination is the easiest and most straightforward tool to make a correct diagnosis.

Quadricuspid aortic valve associated with unruptured sinus of Valsalva aneurysm

Quadricuspid aortic valve is a rare congenital anomaly. It may present as an isolated anomaly but is occasionally associated with aortic regurgitation. Sinus of Valsalva aneurysm (SVA) is also an infrequent congenital anomaly, typically associated with tricuspid aortic valves. There are only a few reported cases of SVA (ruptured) associated with quadricuspid aortic valves in the literature. We report the first case of the association of quadricuspid aortic valve with an unruptured SVA in an adult patient.

Sinus of Valsalva aneurysms--47 years of a single center experience and systematic overview of published reports

A retrospective study was undertaken to review demographic data, clinical presentation, outcomes, and long-term results of surgical repair of sinus of Valsalva aneurysms (SVAs). SVAs are a rare anomaly. Surgery is the treatment of choice. A retrospective review of an institutional database identified 86 patients who underwent SVA repair from 1956 to 2003. Follow-up ranged from 3 months to 40 years. The median age was 45 years (range 5 to 80). Approximately 44% of the patients had associated aortic regurgitation. Ruptures occurred in 34% of patients. The predominant fistula was from the right sinus of Valsalva to the right ventricle. Most (65%) were diagnosed by echocardiography, and the remaining (35%) were diagnosed on cardiac catheterization. All subjects underwent SVA repair. Seventy-two patients (84%) underwent other cardiac procedures at the time of aneurysm repair. Six patients (7%) died perioperatively, and the actuarial 10-year survival rate was 63%. In conclusion, echocardiography is the most frequently used diagnostic tool. The most common site of the aneurysm was the right coronary sinus. The concomitant surgical repair of associated ventricular septal defect, atrial septal defect, and the aortic valve is often required. Elective surgical repair can be performed with low risk.

Geographical variations in the presentation of ruptured aneurysms of sinuses of valsalva: evaluation of surgical repair

From 1981 to 1992, 13 male and 7 female patients underwent surgical correction for ruptured aneurysms of sinus of valsalva. A total surgical experience of 22 procedures including 2 reoperations is presented, accounting for 1.37% of open heart surgery for congenital heart disease at PGIMER Chandigarh. Ninety percent were in the 20- to 40-year age group. Forty-five percent of patients had symptoms of > 1-year duration (range 2 months to 20 years) and catastrophic onset of symptoms was noted in four (18%). All patients had localized aneurysms originating either in right coronary sinus (14 pts) or noncoronary sinus (8 pts). Sites of origin and rupture are detailed. Associated congenital abnormalities such as ventricular septal defect (VSD) (13 pts), aortic regurgitation (3 pts), and left superior vena cava and atrial septal defect (ASD) (1 pt each) were noted. The data pertaining to Oriental and Western groups of patients were analyzed, and the differences in age, mode of presentation, site of origin, rupture, and the spectrum of associated abnormalities were elucidated. The majority of the patients (86.4%) were operated by the Bicameral approach. Repair was tailored according to the extent and severity of the defect in the sinus of Valsalva and aortic valve annulus and also the presence and site of VSD.