Sinus of valsalva aneurysm: A single institutional experience with 216 patients over 30 years

A Rare Case of Sinus of Valsalva Aneurysm Rupture Resulting From Infective Endocarditis and Requiring Surgery

Infective endocarditis (IE) is a life-threatening infection. Although some cases with early diagnosis are treated with antibiotics only, others are associated with intracardiac complications and/or sepsis, necessitating intensive care and surgical repair. Congenital heart disease (CHD) and atopic dermatitis (AD) are risk factors for IE, with AD being a common comorbidity in children with CHD-related IE due to impaired skin barrier function. In the present case, the patient's untreated AD compromised his skin integrity, serving as a portal for Staphylococcus aureus entry, which was subsequently isolated from blood cultures. We report a rare case of IE with sinus of Valsalva aneurysm rupture (SoVR) requiring surgical repair. A two-year-old boy with a ventricular septal defect and AD was referred to our hospital for IE with sepsis. Blood culture was positive for methicillin-susceptible Staphylococcus aureus. The patient entered the intensive care unit (ICU), and antibiotic administration was started. Transthoracic echocardiography (TTE) showed a vegetation and SoVR with perforation of the right coronary cusp, leading to an aorta-to-right ventricle shunt. On the 11th day after admission, TTE showed dilatation of the ruptured sinus of Valsalva and exacerbation of the aorta-to-right shunt. Surgical repair was performed on the same day. The postoperative course went well, and the patient was extubated on postoperative day (POD) five and discharged from the ICU on POD nine. TTE showed trivial aortic regurgitation and diminished aorta-to-right ventricle shunt. Antibiotics were discontinued one month after admission. The patient was discharged from our hospital on the 40th day after admission. In this case, the underlying AD likely contributed to the IE by serving as an entry point for S. aureus. Close follow-up and systemic management, always with surgical treatment in mind, were important for determining the timing of surgical intervention. Clinicians should also recognize the role of AD in increasing IE risk and emphasize proactive skin care for CHD patients to prevent severe infections.

Surgical Repair of a Giant Unruptured Left Sinus of Valsalva Aneurysm in an Older Patient: A Case Report

A giant unruptured left sinus of Valsalva aneurysms is extremely rare. Even if asymptomatic, surgical repair should be performed, considering comorbidities, and patient's physical condition. In this case, patch repair with coronary artery bypass, correction of sinotubular junction, and aortic annulus for aortic regurgitation benefited the older patient.

[Atypical presentation of ruptured aneurysmal right sinus of Valsalva with severe aortic insufficiency]

Aneurysm of the Sinus of Valsalva (ASV) is a rare abnormality and affects less than 0.1% of the general population. We describe the case of a 37-year-old woman with a clinical picture characterized by dyspnea, palpitations, and syncope of 6 years of evolution. The echocardiographic study revealed a right ASV with a sub pulmonary interventricular perforation of 8mm and producing a regurgitant jet into the right ventricle, causing dilatation of the right ventricular outflow tract, pulmonary artery, and severe aortic insufficiency Carpentier DI. The patient underwent successful repair of the defect and interventricular perforation, and valve replacement was not necessary. Timely echocardiographic diagnosis and early surgery are the main predictors that make the difference between an excellent outcome and certain death.

Sinus of Valsalva aneurysm: Defining the optimal approach

Sinus of Valsalva aneurysm (SVA) is relatively rare, especially in Western countries, and reports on long-term results after surgical SVA repair in a sizable patient cohort are scarce. In this issue of the Journal of Cardiac Surgery, Chaganti and colleagues publish their surgical experience over the past 30 years in 216 patients with SVA. SVAs were closed via a dual approach, with (1) patch closure (80%) or direct closure (20%) of the base of the fistula through aortotomy and (2) direct closure of the ruptured tip through the chamber of rupture. Aortic valve replacement (9.7%) or repair (6.5%) was performed for moderate to severe aortic regurgitation (AR). There was no hospital mortality. During a mean follow-up of 10 years, no patient had residual/recurrent shunting. The actual survival at 10 years was 99%, with only two deaths. Freedom from moderate or severe AR was 98.5% at 10 years. Early and long-term results after surgical repair of SVA were excellent in their 216 patients with a mean follow-up of 10 years. Their dual approach for SVA was effective in preventing residual/recurrent shunting. The need for AVR in 10% of the patients speaks to the importance of follow-up. The current report provides strong support for surgical repair being the preferred management for SVA.