Sinus of Valsalva aneurysms

Extensive dissection to the coronary sinus of valsalva during percutaneous intervention in right coronary artery-a case report and literature review

Severe retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention (PCI), but life threatening. There is some literature about this complication, but this particular complication has not been previously reported in China. We present a case of coronary artery dissection during a PCI in which progressively extended retrogradely into the sinus of valsalva, and was successfully treated with stenting without an operation.

Congenital anomalies in the baboon (Papio spp.)

BACKGROUND

A comprehensive survey of the prevalence of congenital anomalies in baboons has not been previously reported. We report the congenital anomalies observed over a 26-year period in a large captive baboon colony.

METHODS

A computer search was performed for all baboon congenital anomalies identified at necropsy and recorded on necropsy submissions.

RESULTS

We identified 198 congenital anomalies in 166 baboons from 9972 necropsies (1.66% of total necropsies). The nervous, urogenital, musculoskeletal, and cardiovascular systems were most commonly affected. The most common organs affected were the brain, bone, heart, testicle, kidney, penis, aorta, and skeletal muscle. The most frequent congenital anomalies were blindness, seizures, and hydrocephalus.

CONCLUSIONS

The baboon has an overall frequency of congenital anomalies similar to humans and other non-human primates. Although the most frequently affected systems are similar, congenital anomalies involving the digestive system appear to be less common in the baboon.

A rare case of unruptured sinus of valsalva aneurysm obstructing the right ventricular outflow tract

An unruptured sinus of Valsalva aneurysm is rare and is usually asymptomatic until a symptom associated with its complication develops. Hence, an unruptured sinus of Valsalva aneurysm is not infrequently missed unless echocardiogram is performed with other indications. An unruptured sinus of Valsalva aneurysm rarely protrudes into the right ventricular outflow tract, causing the right ventricular outflow tract obstruction. In this report, I describe a rare case of unruptured sinus of Valsalva aneurysm producing the right ventricular outflow tract obstruction, which was incidentally detected by echocardiography.

Valsalva sinus aneurysms: findings at CT and MR imaging

Aneurysms of the Valsalva sinus (aortic sinus) can be congenital or acquired and are rare. They are more common among men than women and among Asians than other ethnic groups. Nonruptured aneurysms may be asymptomatic and incidentally discovered, or they may be symptomatic and manifest acutely with mass effect on adjacent cardiac structures. Ruptured Valsalva sinus aneurysms result in an aortocardiac shunt and may manifest as insidiously progressive congestive heart failure, severe acute chest pain with dyspnea, or, in extreme cases, cardiac arrest. Although both ruptured and nonruptured Valsalva sinus aneurysms may have potentially fatal complications, after treatment the prognosis is excellent. Thus, prompt and accurate diagnosis is critical. Most Valsalva sinus aneurysms are diagnosed on the basis of echocardiography, with or without angiography. However, both electrocardiographically gated computed tomography and magnetic resonance (MR) imaging can provide excellent anatomic depiction, and MR imaging can provide valuable functional information.

Familial unruptured sinus of Valsalva aneurysm obstructing the right ventricular outflow tract

A case demonstrating compression of the right ventricular outflow tract by an unruptured coronary sinus of Valsalva aneurysm in which repair resulted in symptomatic improvement is presented. The pathology report revealed that the patient's younger brother had died from a ruptured aneurysm of the coronary sinus of Valsalva. The present report is the first to describe a familial unruptured coronary sinus of Valsalva aneurysm raising questions regarding the screening of relatives of patients with sinus of Valsalva aneurysms of unknown etiology.

Transcatheter closure of a ruptured sinus of valsalva aneurysm

BACKGROUND

Ruptured sinus of Valsalva aneurysms (RSVA) can be associated with ventricular septal defects or isolated lesions. Surgical repair has been the traditional treatment of for the RSVA. The results of transcatheter closure of the RSVA in 4 patients are reported.

METHODS AND RESULTS

From 2003 to 2004, 4 patients (2 males and 2 females) aged from 18 years to 47 years with RSVA were identified. The diagnosis of RSVA was made based on a combination of several imaging modalities. The drainage site of the RSVA was right ventricle in 2, and right atrium in remaining 2. All patients underwent general anesthesia and transesophageal echocardiographic (TEE) monitoring during the procedure. Transcatheter closure with an Amplatzer duct occluder was attempted in all 4 patients. The size of the Amplatzer duct occluder selected was up to 2 mm larger than the maximal diameter of the aortic opening site of the RSVA as measured on TEE images. The attempt to deploy an Amplatzer duct occluder was successful in 3 and a Gianturco coil was deployed in 1. Follow-up (3-18 months) echocardiography showed neither residual shunt nor aortic regurgitation in any of the patients.

CONCLUSION

The transcatheter technique is a safe alternative in the treatment of RSVA; however, a longer follow-up is mandatory.

Reimplantation Technique (David Operation) for Multiple Sinus of Valsalva Aneurysms

Sinus of Valsalva aneurysms are relatively uncommon, and surgical repair is indicated at the time of diagnosis whether or not symptoms are present. This generally entails closure using a patch technique because usually only one sinus is involved. We report here the successful treatment of multiple sinus of Valsalva aneurysms using a David reimplantation valve-sparing root replacement.

Intracardiac shunting of ruptured Sinus of Valsalva aneurysm in a patient presented with acute myocardial infarction: role of 64-slice MDCT

Rupture of Sinus of Valsalva aneurysm (SVA) may be either congenital or acquired. This report describes a case of intracardiac shunting of a ruptured SVA of atherosclerotic origin to the right atrium, presenting with acute myocardial infarction. The sinus of Valsalva aneurysm and the intracardiac shunt track into the right atrium was not defined by the two-dimensional echocardiography could be seen by 64-slice multi detector computed tomography (MDCT).

Multi-slice CT demonstration of sinus of Valsalva rupture

Aneurysms of the sinus of Valsalva are rare. We report here the case of a 56-year-old man with a ruptured aneurysm of sinus of Valsalva with flow into the right ventricle which was diagnosed non-invasively by 64-row multi-slice computed tomographic (CT) imaging. The right sinus of Valsalva aneurysm rupturing into the right ventricular outflow region might be silent or symptomless in many cases. The patient also had mild symptom. For anatomical demonstration, contrast-enhanced CT was performed. Although the ruptured sinus of Valsalva was initially diagnosed by echocardiography, CT images did give our surgeons a better three-dimensional appreciation when surgical repair was performed. Multi-slice CT imaging should be considered the technique of choice for both diagnosis and follow-up examination of the aneurysm of sinus of Valsalva and its rupture.

Ruptured sinus of Valsalva aneurysm in two patients with subarterial ventricular septal defect

Rupture of a sinus of Valsalva aneurysm (SVA) is a rare, but life-threatening, event and requires immediate recognition and intervention. We present two previously healthy and physically active patients who were 12 and 33 years of age when rupture of a right coronary SVA into the right ventricle occurred. A subarterial ventricular septal defect (VSD) was detectable in both patients. Cardiac surgery involved VSD closure as well as reconstruction of the aortic valve. Considering complications of subarterial VSD, such as aortic cusp prolapse, aortic insufficiency or SVA, we suggest close follow-up and surgical closure of the VSD in case of any aortic valve deformity.

Surgical Repair of Postoperative Left Sinus of Valsalva Aneurysm Dissecting Into the Interventricular Septum

We describe the dissection of the interventricular septum by unruptured aneurysm of the left sinus of Valsalva in a patient who had undergone aortic valve replacement for rheumatic aortic valve insufficiency 5 years previously. The patient had worn a permanent pacemaker for 1 year to manage complete atrioventricular block. Sufficient information was provided by echocardiography and aortography to confirm the diagnosis. Operative correction consisted of obliteration of the aneurysm sac and closure of the outward orifice with a Dacron patch from the side of the aortic sinus.

The Four Seasons of Ruptured Sinus of Valsalva Aneurysms: Case Presentations and Review

The sinuses of Valsalva are 3 distinct outpouchings of the aortic wall associated with the 3 cusps of the aortic valve that may develop aneurysmal dilation because of weakness of or injury to the sinus wall. Rupture of a sinus aneurysm can create an aortocardiac fistula. Ruptured sinuses of Valsalva aneurysms (RSVAs) may present a diagnostic dilemma because of their varied clinical presentations. However, if included on a differential, they are easily diagnosed and surgically treated. In our article we detail 4 RSVA cases, each demonstrating a manner in which an RSVA may present clinically. Our first case involves a 68-year-old patient with an RSVA diagnosis after presenting with cardiac arrest and congestive heart failure. Our second case involves a 42-year-old patient with an RSVA diagnosis in the context of acute chest pain, ischemic electrocardiographic changes, and hypotension. Our third RSVA case involves a 60-year-old patient who presented solely with a sudden onset of lower-extremity edema. Our fourth case involves a 46-year-old asymptomatic patient with RSVA diagnosed during a routine physical exam. Comparisons of reported case series from around the world illustrate RSVA epidemiology, concomitant lesions, clinical presentations, and repair techniques. Comparisons of Eastern and Western series reveal that the incidence of RSVAs is higher in Eastern than in Western countries, with a 4:1 male preponderance across ethnic lines. Among the Eastern series reporting RSVAs, ventricular septal defects and aortic valve incompetence were the only frequently associated concomitant lesions. In contrast, Western series of RSVAs showed a wide range of concomitant lesions. The difficulty in diagnosing RSVAs is mainly due to the variability of their clinical impact and presentation. These factors largely depend on the cardiac chamber into which the aortocardiac fistula forms. However, once RSVA is on a differential, the advent of transesophageal and transthoracic radiography has made RSVA diagnosis relatively easy. Surgical repairs of RSVAs are of low risk and generally have an excellent long-term prognosis. As a result, many authors believe that early surgical intervention in patients with an RSVA is justified. Among the series studied, there is evidence that the patch technique is the safest approach because of its lower association with fistula recurrence. This article highlights for the clinician the diversity of clinical presentations of this often overlooked disorder.

Percutaneous closure of a ruptured sinus of Valsalva aneurysm using the Amplatzer Duct Occluder

Sinus of Valsalva aneurysms are rare congenital anomalies. When they rupture, they can lead to the development of biventricular failure as a result of systemic-pulmonary shunting. Surgical repair has been the traditional treatment for these aneurysms. We present a case of a 54 year old man in whom a ruptured sinus of Valsalva aneurysm was successfully closed using a catheter-based approach with the Amplatzer Duct Occluder.

Coexistence of giant aneurysm of sinus of Valsalva and coronary artery aneurysm associated with idiopathic hypereosinophilic syndrome

Aneurysms of the coronary sinuses of Valsalva and coronary artery aneurysms are uncommon cardiac anomalies, and cases in which these two uncommon lesions occur at the same time are extremely rare. A case of a woman with unstable angina who had a giant aneurysm of the left coronary sinus and multiple coronary artery aneurysms associated with an idiopathic hypereosinophilic syndrome is presented. Her sustained eosinophilia, elevated eosinophilic cationic protein concentration, and pathological findings of eosinophil infiltration of the aortic wall suggested the association of eosinophilia induced vascular injury as the cause of these aneurysms. This is the first such case to survive following surgical treatment.

Ruptured sinus of Valsalva aneurysm simulating endocarditis

A previously healthy, 31-year-old man was evaluated in the emergency department after being violently assaulted. A harsh, continuous murmur was noted on physical examination. Transthoracic and transesophageal echocardiograms were interpreted as showing a ruptured sinus of Valsalva aneurysm with a shunt into the right atrium and a tricuspid valve vegetation. The patient was treated with antibiotics for presumed endocarditis. Subsequent echocardiographic and surgical evaluation showed no evidence of past or present endocarditis. Rather, the sinus of Valsalva aneurysm and rupture gave the appearance of a valvular mass. This report shows some of the potential pitfalls in the delineation of abnormalities related to sinus of Valsalva aneurysms and rupture.

Endoaneurysmal repair of a congenital right coronary sinus aneurysm

An 82-year-old woman complained of lightheadedness, dizziness, syncope, palpitations, and chest pains of 2 years' duration. Chest X-ray demonstrated cardiomegaly, while transesophageal echocardiography (TEE) disclosed an aneurysm of the right coronary sinus (RCS), 6 x 6 cm in diameter, filled with clots and obstructing the right ventricular (RV) outflow tract. A total cardiopulmonary bypass was instituted with hypothermia to 28 degrees C esophageal temperature. After removing the clots, we applied an endoaneurysmal repair with a synthetic patch to the entry of the aneurysm and closed the aneurysm itself. We recommend our approach of an endoaneurysmal repair for similar aneurysms of the coronary sinus of Valsalva.

Dilatation of sinus of Valsalva with displacement and compression of the left coronary artery causing sudden death

A 69-year-old male patient is described who presented with angina and congestive heart failure 12 years after his aortic valve had been replaced by a bioprosthesis for aortic stenosis. The aortogram showed massive dilatation of the aortic root. Coronary angiography demonstrated a displaced and narrowed left main and circumflex coronary artery. The patient died suddenly before his scheduled elective operation. At autopsy the left main and circumflex coronary artery were patent but severely compressed by extensive dilatation of the aortic root, predominantly of the left sinus of Valsalva. His sudden death was most likely due to external constriction of the left coronary artery with subsequent ischemia and ventricular fibrillation.

Congenital sinus of valsalva aneurysm dissecting into the interventricular septum with left ventricular communication

In this report we describe a case of a right coronary sinus of Valsalva aneurysm dissecting into the interventricular septum with spontaneous rupture into the left ventricle. Sufficient information was provided by echocardiography, cardiac catheterization, and aortography to confirm the diagnosis. Surgical findings were in complete accordance with cross-sectional and color flow Doppler imaging by transthoracic and transesophageal approaches.

Transcatheter closure of a ruptured aneurysm of the sinus of Valsalva

A ruptured aneurysm of the sinus of Valsalva in a man of 34 was closed by a transcatheter technique with a 12 mm modified Rashkind umbrella device.