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Aboukhoudir F, Jaussaud N, Rekik S, Pankert M. [Ruptured sinus of Valsalva aneurysm presenting as an idiopathic pericardial effusion]. Ann Cardiol Angeiol (Paris) 2021; 70:360-366. [PMID: 34452732 DOI: 10.1016/j.ancard.2021.08.002] [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: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
Aneurysm of the sinus of Valsalva is a rare cardiac condition, which could be either acquired or congenital. The most frequent complication is a rupture into right cavities or more rarely into left cavities or pericardium. Rupture could be either asymptomatic or poorly tolerated with hemodynamic instability, acute heart failure or sudden death. We report the case of a 24-year-old patient with no past medical history presenting with a partially ruptured sinus of Valsalva into the pericardium and in whom the initial diagnosis was idiopathic pericardial effusion; we describe diagnostic modalities and management.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France; Avignon université EA4278 laboratoire de pharm Écologie cardiovasculaire, Avignon, France.
| | - N Jaussaud
- Département chirurgie cardiaque,CHU La Timone, APHM ,Marseille,France
| | - Sofiéne Rekik
- Service de cardiologie, centre hospitalier Nord Franche comté, Belfort, France.
| | - Mathieu Pankert
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
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Furui M, Dillon J, Akhtar KMA, Bin Ja'apar AN. Ruptured sinus of Valsalva aneurysm with ventricular septal defect complicated by preoperative cardiogenic shock, cardiac arrest, and multiple organ dysfunction: a rare survivor and review of contemporary literature. J Surg Case Rep 2020; 2020:rjaa567. [PMID: 33425326 PMCID: PMC7778375 DOI: 10.1093/jscr/rjaa567] [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: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 11/23/2022] Open
Abstract
Sinus of Valsalva aneurysm (SVA) is a relatively rare cardiac condition, in which the patient is usually asymptomatic. However, once this aneurysm ruptures, patients present with acute symptoms of heart failure. Timely surgical intervention is essential. We present the case of a 27-year-old woman, who had a ruptured SVA with a ventricular septal defect (VSD). The patient collapsed before the emergency operation and needed cardiopulmonary resuscitation. The patient required preoperative high inotoropic support and postoperative management was difficult because of multiple organ dysfunction. However, the patient recovered after using inhaled nitric oxide and veno-venous hemofiltration and tracheostomy, and was discharged with no further complications. To the best of our knowledge, no such case of a ruptured SVA with VSD, complicated by preoperative cardiac arrest and multiple organ dysfunction that culminated in a successful recovery, has been reported to date.
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Affiliation(s)
- Masato Furui
- Cardiothoracic Surgery Department, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Jeswant Dillon
- Cardiothoracic Surgery Department, Institut Jantung Negara, Kuala Lumpur, Malaysia
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Slautin A, Mikulenka V, Hlubocký J, Novotný R, Špaček M, Vondráček V, Lindner J. Ruptured non-coronary sinus of Valsalva aneurysm into the right atrium in 44-year-old patient. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McGregor PC, Temtanakitpaisan Y, Hiltbolt A, Aragam JR. A spectrum of sinus of Valsalva aneurysm-From the young to the old. Echocardiography 2017; 34:1524-1530. [DOI: 10.1111/echo.13655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Pei-Chun McGregor
- Department of Cardiology; Boston Veterans Affairs Healthcare System; Harvard Medical School; West Roxbury MA USA
| | | | - Aimee Hiltbolt
- Department of Cardiology; Boston Medical Center; Boston MA USA
| | - Jayashri R. Aragam
- Department of Cardiology; Boston Veterans Affairs Healthcare System; Harvard Medical School; West Roxbury MA USA
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Gilbert J, Sheppard MN, Byard RW. Sudden Infant and Early Childhood Death and Sinus of Valsalva Pseudoaneurysms. J Forensic Sci 2016; 62:531-535. [PMID: 27864952 DOI: 10.1111/1556-4029.13293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/14/2016] [Accepted: 06/26/2016] [Indexed: 11/27/2022]
Abstract
Two cases of occult pseudoaneurysms of the sinus of Valsalva (SoV) are reported to demonstrate different etiologies and lethal mechanisms. A previously well 9-month-old boy who suffered an unexpected fatal cardiorespiratory arrest was found at autopsy to have a ruptured pseudoaneurysm of the left SoV resulting in lethal hemopericardium. A 13.5-month-old boy died soon after presenting with a 24-h history of poor feeding and reduced urine output. At autopsy, destruction of the noncoronary cusp of the aortic valve by bacterial endocarditis was found with extension of the inflammation into a pseudoaneurysm of the SoV with surrounding abscess formation involving the atrioventricular node. Death was most likely due to an arrhythmia. Pseudoaneurysms of the SoV are exceedingly rare but may result in sudden/unexpected death in infancy and early childhood from rupture or involvement of the conduction system or myocardium. Detailed cardiac examination is essential in all unexpected deaths in early life.
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Affiliation(s)
- John Gilbert
- Forensic Science SA, 21 Divett Place, Adelaide, 5000, Australia
| | - Mary N Sheppard
- Cardiovascular Pathology Unit, St Georges Medical School, London, SW170RE, UK
| | - Roger W Byard
- Forensic Science SA, 21 Divett Place, Adelaide, 5000, Australia.,School of Medicine, The University of Adelaide, Frome Rd, Adelaide, 5005, Australia
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Chua JH, Methangkool E, Cha CM, Mahajan A. The Use of Real-Time Three-Dimensional Transesophageal Echocardiography for Percutaneous Closure of a Ruptured Sinus of Valsalva Aneurysm. J Cardiothorac Vasc Anesth 2014; 28:e4-e6. [DOI: 10.1053/j.jvca.2013.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Indexed: 11/11/2022]
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Congenital aortic sinus aneurysm causing sudden unexpected death in a 56-year-old woman. Am J Forensic Med Pathol 2009; 30:195-7. [PMID: 19465818 DOI: 10.1097/paf.0b013e318187def1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sudden unexpected death due to hemopericardium generally has 2 main causes, rupture of the ascending aorta or rupture of a transmural myocardial infarct. We report an unusual cause of fatal hemopericardium in a 56-year-old woman that occurred in the setting of a motor vehicle mishap.At autopsy, 300 mL of blood were present in the pericardial sac, due to rupture of a previously undetected congenital aortic sinus aneurysm. The low velocity of the automobile at the time of impact with a fence, and the absence of vehicle-related trauma, led to the conclusion that rupture of the aneurysm caused the motor vehicle mishap, rather than vice versa. Because of the typically silent nature of such aneurysms, it is likely that their rupture will occur out-of-hospital and require a forensic investigation.
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Fujii T, Sumiyoshi S, Koga T, Nishizaka M, Matsukawa R, Kuwano H, Sueishi K. An autopsy case report of annuloaortic ectasia with cardiac tamponade ruptured from an aneurysm of the right Valsalva sinus. Pathol Res Pract 2007; 203:671-5. [PMID: 17646055 DOI: 10.1016/j.prp.2007.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 04/26/2007] [Accepted: 05/02/2007] [Indexed: 11/20/2022]
Abstract
Annuloaortic ectasia (AAE) is a clinicopathologic condition with primary or secondary dilatation of the aortic annulus and aneurysm of the proximal thoracic aorta, leading to aortic regurgitation. We herein report an autopsy case of a Japanese 57-year-old male with AAE who died of a cardiac tamponade rupture from the sinus of the right coronary. The wall of the aortic root, particularly that of the sinus of the right coronary Valsalva, underwent extensive fibrosis with loss or fragmentation of the elastic lamina in the medial layer and perforation directly into the pericardial space. The adventitia of the proximal aorta to the aortic arch was diffusely fibrotic with both acute and chronic hemorrhage and chronic inflammatory infiltrate. However, the ascending aortic media was largely intact, except for focal laminar necrosis at the center of the medial layer; no medial cystic necrosis, laminar necrosis, or mesoaortitis/panaortitis was present in the thoracic or abdominal aorta, nor in the main aortic branches, which was suggestive of Takayasu disease and giant cell arteritis. Thus, this patient was diagnosed to have idiopathic AAE with sustained peri-aortic hemorrhage, and he finally died of a cardiac tamponade resulting from an aneurysmal rupture.
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Affiliation(s)
- Takaaki Fujii
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Abstract
Sinus of Valsalva aneurysms are rare cardiac anomalies which may be acquired or congenital, most commonly involving the right or noncoronary sinuses. The congenital aneurysms are more common and often caused by weakness at the junction of the aortic media and the annulus fibrosus. Acquired aneurysms are caused by conditions affecting the aortic wall, such as infections (syphilis, bacterial endocarditis, or tuberculosis), trauma, or connective tissue disorders. Unruptured aneurysms are usually found incidentally during diagnostic studies. More commonly, sinus of Valsalvaaneurysms are diagnosed after clinical sequelae of rupture. Diagnosis of sinus of Valsalva aneurysm is facilitated by echocardiography, contrast aortography, and more recently, magnetic resonance imaging. Repair is generally required for ruptured aneurysms; unruptured aneurysms encroaching on nearby structures, causing myocardial ischemia, or having the potential to rupture warrant repair. A review of the literature is presented focusing on anatomy, clinical presentation of ruptured and unruptured aneurysms, noninvasive diagnostic modalities, and techniques for repair of this anomaly.
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Affiliation(s)
- Dmitriy N Feldman
- Division of Cardiology, New York Presbyterian Hospital-Weill Medical College of Cornell University, NY 10021, USA.
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Abstract
Aneurysms of the sinus of Valsalva (ASVs) are rare. They can be congenital or acquired through infection, trauma, or degenerative diseases. They frequently co-occur with ventricular septal defects, aortic valve dysfunction, or other cardiac abnormalities. Although unruptured ASVs are usually asymptomatic, ruptured ASVs often cause symptoms similar to those of heart failure and produce a continuous, mechanical-sounding murmur. Transsternal or transesophageal echocardiography is usually effective in detecting ASVs. Because symptomatic ASVs pose significant risks for the patient, and because the repair of asymptomatic ASVs generally produces excellent outcomes, surgery is indicated in most cases. The primary goals of surgical repair are to close the ASV securely, remove or obliterate the aneurysmal sac, and repair any associated defects. Operative mortality is generally low except in patients with concomitant bacterial endocarditis or other infections. Late events are uncommon and tend to be related to aortic valve prothesis or Marfan syndrome.
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Affiliation(s)
- David A Ott
- Division of Cardiovascular Surgery, the Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA.
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Answer. CAN J EMERG MED 2000. [DOI: 10.1017/s1481803500007399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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