Surgical repair of ruptured sinus of Valsalva aneurysm: 13-year single center experience

Massive sinus of Valsalva aneurysm with an associated bicuspid aortic valve: A rare clinical image

A sinus of Valsalva aneurysm is a rare cardiac anomaly characterized by an abnormal dilatation of the aortic root. This occurs due to a weakened elastic lamina at the junction of the aortic media and the annulus fibrosus. The aneurysm can be congenital or acquired and comprises up to 3.5% of all congenital cardiac defects. Due to the aneurysm’s physiologic function and location, it can present significant clinical consequences in both the rupture and unruptured state. We present the case of a middle-aged male with no significant medical history who was found to have a massive unruptured sinus of Valsalva aneurysm. He was treated surgically with no postoperative complications.

Application of extracorporeal membrane oxygenation in the remote transport of a patient with a ruptured sinus of Valsalva aneurysm: a case report

Background

A ruptured sinus of Valsalva aneurysm can lead to rapid heart failure and sudden cardiac death. Management of patients who develop severe heart failure and need to be transferred to a specialized hospital for surgical treatment can be challenging. In patients with severe shock due to a ruptured sinus of Valsalva aneurysm into the right atrium, extracorporeal membrane oxygenation (ECMO) transport is an effective means to ensure patient safety, but increases the right cardiac load. We report the experience of veno-arterial (VA) ECMO transport in the treatment of acute cardiogenic shock caused by rupture of a congenital sinus of Valsalva aneurysm.

Case presentation

We describe the case of an 18-year-old male who began having acute episodes of chest pain, shortness of breath, palpitations, and dizziness 18 h before presenting to the emergency department. An echocardiogram revealed an acute ruptured sinus of Valsalva aneurysm and a shunt to the right atrium. The patient presented with severe shock. VA-ECMO was administered to ensure safe transport to the cardiac center. The outcome of emergency surgical repair was good. The patient was on ECMO for 8 h. He returned to the general ward after 7 days and was successfully discharged after 40 days. He had good exercise tolerance 2 years after surgery and no evidence of heart failure.

Conclusion

Although ECMO transport can increase right cardiac load, it is an effective and safe method to move patients with severe shock caused by a ruptured sinus of Valsalva aneurysm into the right atrium. Methods to decrease right cardiac load, such as decreasing ECMO flow combined with cardiotonic drugs, should be adopted. Successful treatment involves rapid establishment of cardiopulmonary bypass and urgent repair of the ruptured sinus of Valsalva aneurysm.

Percutaneous closure versus surgical repair for ruptured sinus of valsalva aneurysm: A systematic review and meta-analysis

Objectives

Ruptured sinus of Valsalva aneurysm (RSVA) often has an abrupt onset, and can chest pain, acute heart failure, and even sudden death. The effectiveness of different treatment modalities remains controversial. Thus, we completed a meta-analysis to evaluate the efficiency and safety of traditional surgery vs. percutaneous closure (PC) for RSVA.

Methods

We carried out a meta-analysis using PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Data, and the China Science and Technology Journal Database. The primary outcome was comparing in-hospital mortality between the two procedures, and the secondary outcome was documenting postoperative residual shunts, postoperative aortic regurgitation, and length of hospital stay in the two groups. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships between predefined surgical variables and clinical outcomes. This meta-analysis was conducted using Review Manager software (version 5.3).

Results

The final qualifying studies included 330 patients from 10 trials (123 in the percutaneous closure group, and 207 in the surgical repair group). When PC was compared to surgical repair, there were no statistically significant differences in in-hospital mortality (overall OR: 0.47, 95%CI 0.05-4.31, P = 0.50). However, percutaneous closure did significantly decrease the average length of hospital stay (OR: -2.13, 95% CI -3.05 to -1.20, P < 0.00001) when compared to surgical repair, but there were no significant between-group differences in the rates of postoperative residual shunts (overall OR: 1.54, 95%CI 0.55-4.34, P = 0.41) or postoperative aortic regurgitation (overall OR: 1.54, 95%CI 0.51-4.68, P = 0.45).

Conclusion

PC may become a valuable alternative to surgical repair for RSVA.

Surgical Repair of a Sinus of Valsalva Aneurysm

A surgically challenging case of an unruptured Sinus of Valsalva aneurysm (SoVA) with severe aortic regurgitation (AR) due to cusp prolapse is presented. Sinus reconstruction with a patch cut out from the sinus portion of a Gelweave Valsalva graft (Terumo Vascutek) was performed. Intraoperative measurements showed insufficient effective height of the right coronary cusp; therefore, cusp plication and pericardial patch augmentation of the right coronary cusp were performed with satisfying result.

Incidental detection of ruptured sinus of Valsalva aneurysm and coronary abnormality in a patient with penetrating chest trauma

Aortic sinus of Valsalva aneurysm is a rare congenital or acquired anomaly with a potential for rupture into adjacent cardiac chambers. Ruptured aneurysm of the sinus of Valsalva leads to volume overload of the receiving chamber and should be repaired as soon as the diagnosis is made. Here, we present a young patient with history of chest trauma leading to discovery of an asymptomatic ruptured sinus of Valsalva aneurysm.

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.