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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.
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Paymard M, Higgins MD, Sinhal A, Musameh MD. Surgical or Percutaneous Repair of Sinus of Valsalva Rupture: Case Series and Literature Review. Heart Views 2023; 24:148-152. [PMID: 37584018 PMCID: PMC10424757 DOI: 10.4103/heartviews.heartviews_96_22] [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: 10/16/2022] [Accepted: 05/11/2023] [Indexed: 08/17/2023] Open
Abstract
The rupture of the sinus of the Valsalva aneurysm is a rare but very serious condition. Rapid and accurate diagnosis and prompt treatment are critical for these cases. We present two cases of sinus of Valsalva ruptures. One case was managed with open surgical repair and the second case was treated percutaneously. We have discussed these two therapeutic approaches available to treat sinus of Valsalva rupture.
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Affiliation(s)
- Mohammad Paymard
- Department of Cardiology, The Canberra Hospital, Canberra, Australian Capital Territory, Mackay, Queensland, Australia
| | - Mark Daniel Higgins
- Depatment of Cardiology, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Muntaser D. Musameh
- Depatment of Cardiology, Mackay Base Hospital, Mackay, Queensland, Australia
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Abstract
Ruptured sinus of Valsalva aneurysm is a rare entity in children. To our knowledge, this is the youngest child reported in the literature with a sinus of Valsalva ruptured aneurysm being successfully treated percutaneously using an AmplatzerTM Duct Occluder II Additional Sizes device.
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Ruptured sinus of Valsalva aneurysms - our surgical experience of 7 years. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:100-104. [PMID: 34386051 PMCID: PMC8340639 DOI: 10.5114/kitp.2021.107471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/18/2021] [Indexed: 12/01/2022]
Abstract
Introduction Aneurysms of sinuses of Valsalva are rare aortic anomalies having an incidence of 1.4–4.94% in the Asian population. Spontaneous rupture is the most common complication and ruptured aneurysms usually present with congestive cardiac failure. Aim Our study was aimed at evaluating the clinical profile of patients with ruptured sinus of Valsalva aneurysms (RSOVA) and their distribution, the surgical management and post-operative course. Material and methods We retrospectively identified 21 patients who presented to us with RSOVA over a period of 7 years and underwent surgery for the same. Results RSOVA was more common in young males. Most cases involved the right coronary sinus (RCS) followed by the non-coronary sinus (NCS). The site of rupture was mostly the right ventricular outflow tract or the right atrium. All patients had a relatively asymptomatic post-operative course in the ward. On follow-up, most of the patients were symptom free. Conclusions Surgery on cardiopulmonary bypass with moderate hypothermia with excision of windsock deformity and patching of the rupture site is a safe method of treating ruptured sinus of Valsalva aneurysms. Patients need to be followed up regularly to monitor for the development of aortic regurgitation.
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Gong X, Wang J, Wei L, Zhao T, Hu S. Case Report: Transcatheter Closure of Ruptured Sinus of Valsalva With Ventricular Septal Defect Occluder in a 3-Year-Old Child After Repair of Ventricular Septal Defect. Front Pediatr 2021; 9:751163. [PMID: 34660497 PMCID: PMC8514821 DOI: 10.3389/fped.2021.751163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023] Open
Abstract
Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that can undergo spontaneous rupture into other cardiac chambers or the pericardial space. A ruptured SVA has a very poor prognosis with high morbidity and mortality. These aneurysms often present as a rupture from the right coronary sinus into the right ventricle. Transcatheter closure has become an effective alternative to surgical treatment. However, it has been rarely reported in patients after ventricular defect repair in the past. We here describe a 3-year-and-3-month-old boy who was found to have a ruptured sinus of Valsalva. He underwent surgical closure of a ventricular septal defect at the age of 2 months, which occurred in the non-coronary sinus (NCS) and ruptured into the right atrium. We successfully occluded the ruptured sinus of Valsalva with a ventricular septal occluder.
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Affiliation(s)
- Xueyang Gong
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jundao Wang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Luyao Wei
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tianli Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shijun Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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Yang K, Luo X, Tang Y, Hu H, Sun H. Comparison of clinical results between percutaneous closure and surgical repair of ruptured sinus of Valsalva aneurysm. Catheter Cardiovasc Interv 2020; 97:E354-E361. [PMID: 32865329 DOI: 10.1002/ccd.29216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study was conducted to investigate whether percutaneous closure of ruptured sinus of Valsalva aneurysm (SVA) is as safe and effective as surgery repair. BACKGROUND Percutaneous closure of ruptured SVA has been becoming an alternative to the traditional surgical repair recently. The reports regarding direct comparison of these two treatment options are scarce. METHODS The medical records from the institutional database were retrospectively analyzed. A total of 134 patients were reviewed, including 26 patients undergoing percutaneous closure and 108 patients being treated surgically. To reduce the potential bias, 32 patients from Surgical Repair group were selected by propensity score matching. RESULTS All the ruptured SVAs were successfully closed in each group. No severe procedure-related complications were found in the perioperative period. After matching, there were no significant differences in the baseline clinical characteristics. The median postoperative hospital stays of Matched group were significantly longer than that of Percutaneous Closure group (7 days vs. 1 day, p < .001). Aortic regurgitation, residual shunt and recurrence of SVAs were common complications in both Percutaneous Closure group and Surgical Repair group. CONCLUSIONS The appropriately selected patients with ruptured SVA could be treated by percutaneous closure with an acceptable risk of short-term complications. Though surgical repair remains the main treatment option for ruptured SVAs, percutaneous closure could be considered in patients with a small-size rupture and no associated cardiac abnormalities.
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Affiliation(s)
- Kai Yang
- Center of Structural Heart Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaokang Luo
- Center of Cardiac Surgery for Adults, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Tang
- Center of Cardiac Surgery for Adults, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haibo Hu
- Center of Structural Heart Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hansong Sun
- Center of Cardiac Surgery for Adults, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yang K, Wei MD, Geng WL, Hu HB, Xu ZY, Zhang GJ, Zhao SH. Safety and efficacy of percutaneous closure of ruptured sinus of Valsalva aneurysm. EUROINTERVENTION 2018; 14:e1288-e1294. [PMID: 30327286 DOI: 10.4244/eij-d-18-00294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to evaluate the safety and efficacy of percutaneous closure in patients with a ruptured sinus of Valsalva aneurysm (RSVA). METHODS AND RESULTS A total of 29 patients with RSVA were retrospectively enrolled in our study. All patients were successfully treated by percutaneous closure and had a complete closure at discharge; however, two patients had a trivial procedure-related aortic regurgitation (AR) after the procedure. On a mean follow-up of 29.7±23.8 months (range 1-83 months), the two procedure-related AR disappeared three months and two years after the procedure, respectively. Trivial residual shunt was found in one patient, sinus of Valsalva aneurysm ruptured again in one patient and trivial to moderate AR was found in two patients during the follow-up. CONCLUSIONS In appropriately selected patients with RSVA, percutaneous closure is an attractive alternative to surgery with high technical success and good short-term and midterm outcomes; however, long-term follow-up is mandatory.
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Affiliation(s)
- Kai Yang
- Centre of Structural Heart Disease, Fuwai Hospital and National Centre for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Sinha SK, Khanna NN, Razi M, Krishna V, Jha MJ, Mishra V, Aggarwal P, Goel A, Singh K, Thakur R, Rajan L, Varma CM. Safety and Feasibility of Transcatheter Interruption of Ruptured Sinus of Valsalva Aneurysm Using the Cocoon Duct Occluder: Immediate Results and Mid-Term Follow-Up. Cardiol Res 2017; 8:154-160. [PMID: 28868100 PMCID: PMC5574287 DOI: 10.14740/cr568w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/19/2017] [Indexed: 11/30/2022] Open
Abstract
Background Limited data are available regarding safety and feasibility of transcatheter interruption of ruptured sinus of Valsalva aneurysm (RSOVA) using the Cocoon duct occluder (CDO) with immediate and mid-term follow-up result. Methods Transcatheter closure (TCC) was successfully done among eight patients, whereas five cases, not amenable to TCC, were referred for surgical correction among 13 consecutive patients of RSOVA at LPS Institute of Cardiology, Kanpur between January 2010 and March 2015. Results Their mean age was 26.1 ± 6.9 years. Sites of rupture were from right coronary sinus (RCS) to right atrium (RA) in one (12.5%), right ventricle in one (12.5%), and non-coronary sinus to RA in six patients (75%). The defects (9 - 17 mm) were closed by CDO (12/10 - 20/18 mm) with 100% procedural success. During follow-up (9 - 26 months), there was no residual shunt, progression of AR, infective endocarditis or device embolization. Conclusion TCC of RSOVA appears to be a safe and feasible alternative to surgical therapy, with high technical success and excellent mid-term follow-up.
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Affiliation(s)
- Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | | | - Mahmadula Razi
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vinay Krishna
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mukesh Jitendra Jha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vikas Mishra
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Puneet Aggarwal
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Amit Goel
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Karandeep Singh
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | | | - Chandra Mohan Varma
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
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Sinus of Valsalva Aneurysm: A Rare Cause of Dyspnea. Case Rep Med 2015; 2015:467935. [PMID: 26379711 PMCID: PMC4561312 DOI: 10.1155/2015/467935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/03/2015] [Accepted: 07/21/2015] [Indexed: 11/24/2022] Open
Abstract
Sinus of Valsalva aneurysm (SOVA) is a rare clinical entity. Clinical manifestations can vary from an incidental finding on an imaging study to a life-threatening emergency. We report a case of a 51-year-old female with a large symptomatic left SOVA. Echocardiogram and computed tomography angiography (CTA) of the chest revealed marked dilatation of the left sinus of Valsalva, measuring 7.5 cm. This resulted in superior displacement of the left main coronary artery. Surgical repair of the aneurysm with reimplantation of the right and left coronary arteries was performed in addition to aortic valve replacement (Bentall procedure). The patient had an uneventful postoperative course and remains asymptomatic at the three-month follow-up visit.
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