Giant unruptured sinus of Valsalva aneurysm successfully managed with valve-sparing procedure - a case report

Sinus of Valsalva Aneurysm: A Potential Case of Filamin A Mutation

Filamin A is a protein essential for cytoskeleton production, encoded by the X-lined dominantly inherited FLNA gene. A deficiency in filamin A can lead to cardiac valvular dysplasia and periventricular nodular heterotopia in the brain. Notably, periventricular heterotopia Type 1 has associations with cardiovascular abnormalities. We report the case of a 40-year-old woman who visited the emergency department due to shortness of breath, intermittent desaturation, and vertigo. Initial diagnostic procedures unexpectedly identified a sinus of Valsalva aneurysm on a computed tomography scan of the thorax and MRI brain revealed subependymal nodules in the lateral ventricles, suggesting an FLNA mutation. Multimodal cardiac imaging, including transesophageal echocardiogram, confirmed the aortic root aneurysm diagnosis. Consequently, the patient underwent prophylactic aortic resection and valve replacement surgery. This case underscores the importance of multidisciplinary teamwork in diagnosing and devising a comprehensive treatment plan. Cardiovascular screening for patients with known filamin A function loss might be advantageous. Similarly, genetic testing for family members could help anticipate the disease's progression and suggest prophylactic interventions like aortic root resection.

Not so benign- A rare cause of right ventricular outflow tract ventricular tachycardia in patient with congenital heart disease

Right ventricular outflow tract ventricular tachycardia (RVOT VT) is a well-recognised subtype of idiopathic ventricular tachyarrhythmia and often described in young healthy individuals. This arrhythmia typically occurs in patients with a structurally normal heart, and in this context is generally considered benign. In this case we present a rare association between RVOT VT and a ruptured sinus of Valsalva aneurysm in a patient known to have a restrictive ventricular septal defect. Prompt surgical intervention was necessary to prevent potentially life threatening consequences. The diagnostic and surgical evaluation learnt from this case would be useful to remind clinicians to explore rarer causes of RVOT VT especially when patients have underlying congenital heart disease. This case also highlights the importance of utilizing multi-modality imaging for the anatomical assessment of this pathology, which aids definitive management.

Systolic Ejection Murmurs Due to Unruptured Aneurysm of the Sinus of Valsalva

Aneurysm of the sinus of Valsalva is a rare condition with variable clinical presentation. We present a case of an unruptured aneurysm of the right sinus of Valsalva, in which a systolic ejection murmur was instrumental in the diagnosis. An asymptomatic 72-year-old man was referred to the cardiology department because of a heart murmur. Physical examination was unremarkable except for a grade 3 systolic murmur, loudest at the third left sternal border. Echocardiography revealed a sac-like structure protruding into the right ventricle and attached to the right sinus of Valsalva with a right ventricular outflow tract obstruction during end-systole. Multidetector computed tomography showed an aneurysm of the right sinus of Valsalva with a diameter of 28 × 19 mm; no contrast leakage from the aneurysm was detected. A diagnosis of an unruptured aneurysm of the right sinus of Valsalva was made. Surgical repair was successfully performed, and the murmur disappeared postoperatively. This case underscores the importance of physical examination even in the era of advanced imaging techniques and the need to recognize the wide range of causes of heart murmurs.

Repair of Giant Sinus of Valsalva Aneurysms

Sinus of Valsalva aneurysm (SVA) is a rare, abnormal dilation of the aortic root. Although often asymptomatic, SVAs can be manifested with a variety of symptoms, including rupture, which is a highly lethal condition. Most SVAs are small, and most patients present with aneurysm in a single coronary sinus. We describe the case of a 69-year-old man presenting with ventricular tachycardia cardiac arrest and 2 SVAs, a giant one arising from the right coronary sinus and a smaller one coming from the left coronary sinus. Included in the case presentation is our operative repair video.

Surgical management for unruptured sinus of Valsalva aneurysms: a narrative review of the literature

Unruptured sinus of Valsalva aneurysms (SVAs) are rare cardiac lesions that arise due to congenital or acquired etiologies. They could be asymptomatic or cause various clinical manifestations as a consequence of their mass effect on the coronary arteries, heart valves, and other adjacent structures. While the factors predicting SVA rupture are not fully understood, ruptured SVAs carry a high complication and mortality rate, highlighting the need for early recognition and management of unruptured SVAs. Imaging modalities such as echocardiography, computed tomography (CT), angiography, and magnetic resonance imaging (MRI) are essential in identifying and characterizing the aneurysm as well as associated cardiac anomalies. However, there are no specific guidelines for the diagnosis and management of SVAs. Herein, we performed a contemporary systematic review to examine the presentation, diagnostic tests and findings, as well as outcomes for surgical intervention of unruptured SVAs. We demonstrate that surgical repair remains the preferred method of treatment in order to prevent complications such as rupture or thrombus formation. Surgery should be prompted in patients with symptomatic, large, or rapidly expanding unruptured SVAs, as well as those unruptured SVAs that contain intraluminal thrombi, have a mass effect on surrounding structures, or are recurrent. Surgical outcomes are generally good with favourable prognosis and minimal recurrence.

Large sinus of Valsalva aneurysm presenting as acute coronary syndrome

A sinus of Valsalva aneurysm is a rare defect that is usually asymptomatic. We report a sinus of Valsalva aneurysm arising from the left coronary sinus with compression of the left main coronary artery in a 56-year-old man who presented with worsening chest pain. Coronary imaging revealed a 4.6-cm sinus of Valsalva aneurysm with compression of the left main stem, left anterior descending, and proximal circumflex arteries. He underwent aortic root and ascending aortic replacement. Large sinus of Valsalva aneurysms can be life-threatening and can be managed safely surgically.