Bad company: supracristal VSD presenting with ruptured sinus of valsalva aneurysm. a case presentation with echocardiographic depiction and an analysis of contemporary literature

Hidden behind the mask: misdiagnosis of a ruptured sinus of Valsalva aneurysm in a young male patient-a case report and review of literature

BACKGROUND

Sinus of Valsalva aneurysm is a relatively rare disease accompanied by several severe complications. Patients with an unruptured sinus of Valsalva aneurysm are usually asymptomatic or present with symptoms of dyspnea, easy fatigability, palpitations, or chest pain, whereas a ruptured sinus of Valsalva aneurysm may cause severe symptoms including heart failure, myocardial ischemia, or even cardiac arrest. Misdiagnosis is common in clinical practice owing to the rarity of sinus of Valsalva aneurysm and its highly variable, often atypical clinical presentations, which can mimic more common conditions.

CASE PRESENTATION

We present a rare and interesting case of a patient with a ruptured sinus of Valsalva aneurysm, a 33-year-old Chinese man who was misdiagnosed owing to a series of atypical symptoms, including eyelid and facial edema and dyspepsia. Fortunately, the patient was finally diagnosed with ruptured sinus of Valsalva aneurysm, and transthoracic echocardiography showed the noncoronary sinus of Valsalva aneurysm, which ruptured into the right atrium, accompanied by cardiac enlargement and pericardial effusion.

CONCLUSION

This case highlights the importance of obtaining a complete history and a standardized physical examination, and emphasizes the need to consider ruptured sinus of Valsalva aneurysm in young patients presenting with sudden heart failure without a prior cardiac history, and that transthoracic echocardiography is important in providing an accurate and rapid sinus of Valsalva aneurysm diagnosis.

Ruptured Sinus of Valsalva Aneurysm in a Patient with a Ventricular Septal Defect Who Dropped Out of Lifelong Medical Follow-up

Ruptured sinus of Valsalva aneurysm (RSOVA) is a rare cardiac condition associated with high morbidity and mortality rates. We herein report a 35-year-old man with a history of ventricular septal defect (VSD). He had a history of interrupted hospital visits and presented to the emergency department with dyspnea, palpitations, and dizziness for a few days. Auscultation detected a continuous murmur. Transthoracic echocardiography followed by transesophageal echocardiography demonstrated RSOVA in the right ventricle with an aorto-right ventricular fistula. The fistula was resected, and the aneurysm was surgically repaired. The patient made a good recovery.

Case report: Total thoracoscopic repair of sinus of Valsalva aneurysm combined with ventricular septal defect

The sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly. It can develop into the heart failure if it ruptures, which requires early intervention. However, such congenital anomalies are usually treated using a median sternotomy approach. Here, we report a rare case of SVA combined with a ventricular septal defect in which the patient underwent patch repair of the defects under a total thoracoscopy approach. She was discharged uneventfully and showed no residual shunt or aortic regurgitation postoperatively or at the 12-month follow-up. The total thoracoscopic approach for SVA repair is technically feasible.

Association of ruptured sinus of Valsalva aneurysm and congenital ventricular septal defect: a case series

BACKGROUND

Ruptured sinus of Valsalva aneurysm (RSOVA) is rare, and it is more common in Asians. Typically, the patient presents with acute/subacute shortness of breath (SOB) and chest pain. Echocardiography is the gold standard for diagnosis in most of these cases. Surgery has remained the first line of management.

CASE SUMMARY

We present two cases of RSOVA in which the patients presented to the emergency department with SOB. Their preoperative echocardiography results showed RSOVA into the right ventricle. During surgical repair, ventricular septal defect (VSD) was also found.

DISCUSSION

RSOVA is frequently associated with other congenital anomalies, and most often with VSD. In our cases, we believe that VSDs were missed preoperatively because either the large aneurysmal sacs covered the VSD or there was overlap between the two shunts. Additionally, in the first case, right ventricular pressure was high approaching systemic pressure, which probably reduced the shunt across the VSD. Early intervention is recommended to prevent endocarditis or enlargement of the ruptured aneurysm; long-term results were excellent after surgical repair. Most patients undergo surgery between 20 and 40 years of age, and the reported survival rate is 95% at 20 years. If left untreated, patients typically die of heart failure or endocarditis within 1 year after onset of symptoms.