1
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Kramer BCE, Abdullahi NS, Ten Have LC, van den Elzen APM. Young adolescent with trisomy 13. BMJ Case Rep 2022; 15:e246514. [PMID: 36150723 PMCID: PMC9511538 DOI: 10.1136/bcr-2021-246514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A young adolescent girl with trisomy 13 was admitted twice to the paediatric department: the first time because of haematocolpos due to uterus didelphys and unilateral transverse vaginal septum, and the second time because of heart failure due to ruptured sinus of Valsalva aneurysm. As a consequence of the historical early high mortality rate in trisomy 13, we are not aware of known complications in older patients. With better survival nowadays through childhood, we advise structural ultrasonographic cardiac and female genital screening in trisomy 13 patients reaching adolescent age.
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Affiliation(s)
| | - Najma S Abdullahi
- Pediatrics, Erasmus MC, Sophia Childrens Hospital, Rotterdam, The Netherlands
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2
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Hoda M, Verma A, Alapati S, Alapati S, Yarrabolu TR. Diagnostic paradox: Ruptured aneurysm of sinus of Valsalva simulating tricuspid valve endocarditis. Echocardiography 2017; 34:465-467. [PMID: 28213924 DOI: 10.1111/echo.13479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Rupture of aneurysm of sinus of Valsalva into the right atrium mimicking tricuspid valve endocarditis is a rare presentation. We review a case of spontaneous rupture of aneurysm of sinus of Valsalva into the right atrium presenting as a murmur. Transthoracic echocardiogram showed a mobile mass that appeared to be attached to the tricuspid valve leaflet with moderate tricuspid regurgitation suggestive of tricuspid valve endocarditis. The diagnosis was confirmed as spontaneous rupture of noncoronary sinus in to the right atrium by transesophageal echocardiogram. Patient recovered completely after surgical repair.
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Affiliation(s)
- Mehar Hoda
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX, USA
| | - Arushi Verma
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX, USA
| | - Sridevi Alapati
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX, USA
| | - Srilatha Alapati
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX, USA
| | - Tharakanatha R Yarrabolu
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX, USA.,Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA
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3
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Ghawi H, Engelhardt K, Dixon K, Thankaval P, Ramaciotti C, Lemler MS, Guleserian KJ. Sinus of Valsalva Aneurysm in a Patient With Mosaic Trisomy 13: Case Report and Brief Review of the Literature. World J Pediatr Congenit Heart Surg 2016; 11:NP1-NP6. [PMID: 28036231 DOI: 10.1177/2150135116682465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report describes a unique case involving an obese 16-year-old boy with a mosaic form of trisomy 13 and no previous cardiac history who presented with a new murmur, hypertension, pleural effusions, and congestive heart failure in the context of sore throat and fever. Evaluation revealed a diagnosis of ruptured noncoronary sinus of Valsalva (SOV) aneurysm. The diagnosis and surgical management of a ruptured noncoronary SOV aneurysm in a pediatric patient are briefly outlined. An SOV aneurysm is an anatomic dilation of one of the sinuses of the aortic root. Aneurysmal dilation occurs more commonly in the right aortic sinus (70%-80%), compared to the noncoronary sinus (23%-25%), and more rarely the left coronary sinus (5%). Rupture of these aneurysms has been reported to be both spontaneous and secondary to physical exertion, hypertension, or trauma. Signs of rupture include a continuous murmur, patients may present with chest pain or with symptoms of acute congestive heart failure. Diagnosis, in this case, was made by transthoracic echocardiography with careful interpretation of color Doppler images.
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Affiliation(s)
- Hani Ghawi
- Sidra Medical and Research Center, Ad Dawhah, Doha, Qatar
| | - Kevin Engelhardt
- Children's Health Children's Medical Center Dallas, Dallas, TX, USA.,UT Southwestern Medical Center, Dallas, TX, USA
| | - Keith Dixon
- Children's Health Children's Medical Center Dallas, Dallas, TX, USA
| | - Poonum Thankaval
- Children's Health Children's Medical Center Dallas, Dallas, TX, USA.,UT Southwestern Medical Center, Dallas, TX, USA
| | - Claudio Ramaciotti
- Children's Health Children's Medical Center Dallas, Dallas, TX, USA.,UT Southwestern Medical Center, Dallas, TX, USA
| | - Matthew S Lemler
- Children's Health Children's Medical Center Dallas, Dallas, TX, USA.,UT Southwestern Medical Center, Dallas, TX, USA
| | - Kristine J Guleserian
- Children's Health Children's Medical Center Dallas, Dallas, TX, USA.,UT Southwestern Medical Center, Dallas, TX, USA
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4
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Burri MV, Mahan EF, Nanda NC, Singh A, Pothineni KR, Yelamanchili P, Panwar SR. Superior Vena Cava, Right Pulmonary Artery or Both: Real Time Two- and Three-Dimensional Transthoracic Contrast Echocardiographic Identification of the Echo-Free Space Posterior to the Ascending Aorta. Echocardiography 2007; 24:875-82. [PMID: 17767540 DOI: 10.1111/j.1540-8175.2007.00512.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe the usefulness of contrast echocardiography and live/real time three-dimensional transthoracic echocardiography in characterizing the normal structures imaged posterior to the proximal ascending aorta as superior vena cava, right pulmonary artery, or both.
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Affiliation(s)
- Manjula V Burri
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA
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5
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Santoro G, Pacileo G, Bigazzi MC, Russo MG, Caianiello G, Calabrò R. Transcatheter closure of ruptured sinus of Valsalva aneurysm causing Fontan circulation failure. J Cardiovasc Med (Hagerstown) 2007; 8:470-2. [PMID: 17502768 DOI: 10.2459/01.jcm.0000269713.10565.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Congenital sinus of Valsalva aneurysm is a rare cardiac malformation that usually becomes symptomatic as a consequence of intracardiac or extracardiac rupture. It is difficult to suspect in association with complex cardiac defects and its rupture may be misdiagnosed as progressive aortic regurgitation. This case report refers to a patient with tricuspid atresia submitted to Fontan procedure five years previously, in whom a sinus of Valsalva aneurysm rupture into the accessory ventricular chamber caused rapidly progressive heart failure. The malformation was suspected by echocardiography and treated by percutaneous implantation of an Amplatzer duct occluder, with immediate improvement of the patient's clinical and functional status.
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Affiliation(s)
- Giuseppe Santoro
- Division of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
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6
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Abstract
Sinus of Valsalva aneurysms are rare cardiac anomalies which may be acquired or congenital, most commonly involving the right or noncoronary sinuses. The congenital aneurysms are more common and often caused by weakness at the junction of the aortic media and the annulus fibrosus. Acquired aneurysms are caused by conditions affecting the aortic wall, such as infections (syphilis, bacterial endocarditis, or tuberculosis), trauma, or connective tissue disorders. Unruptured aneurysms are usually found incidentally during diagnostic studies. More commonly, sinus of Valsalvaaneurysms are diagnosed after clinical sequelae of rupture. Diagnosis of sinus of Valsalva aneurysm is facilitated by echocardiography, contrast aortography, and more recently, magnetic resonance imaging. Repair is generally required for ruptured aneurysms; unruptured aneurysms encroaching on nearby structures, causing myocardial ischemia, or having the potential to rupture warrant repair. A review of the literature is presented focusing on anatomy, clinical presentation of ruptured and unruptured aneurysms, noninvasive diagnostic modalities, and techniques for repair of this anomaly.
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Affiliation(s)
- Dmitriy N Feldman
- Division of Cardiology, New York Presbyterian Hospital-Weill Medical College of Cornell University, NY 10021, USA.
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7
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Fedson S, Jolly N, Lang RM, Hijazi ZM. Percutaneous closure of a ruptured sinus of Valsalva aneurysm using the Amplatzer Duct Occluder. Catheter Cardiovasc Interv 2003; 58:406-11. [PMID: 12594713 DOI: 10.1002/ccd.10401] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Savitri Fedson
- Section of Cardiology, Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois 60637, USA
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8
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Rao PS, Bromberg BI, Jureidini SB, Fiore AC. Transcatheter occlusion of ruptured sinus of valsalva aneurysm: innovative use of available technology. Catheter Cardiovasc Interv 2003; 58:130-4. [PMID: 12508216 DOI: 10.1002/ccd.10394] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 9-year-old boy was found to have ruptured sinus of Valsalva aneurysm (RSVA) and aortic coarctation. Following relief of aortic coarctation by balloon angioplasty, transcatheter coil occlusion of the RSVA was performed successfully under transesophageal echocardiographic and fluoroscopic monitoring; bioptome-assisted delivery of 0.052" Gianturco coil was undertaken via a 7 Fr sheath stabilized by an 0.035" guidewire passing through the RSVA and the sheath. This report details the technique of occlusion.
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Affiliation(s)
- P Syamasundar Rao
- Department of Pediatrics, St Louis University School of Medicine/Cardinal Glennon Children's Hospital, St Louis, Missouri, USA.
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9
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Garrido Martín A, Oliver Ruiz JM, González AE, Mesa García JM, Benito F, Sobrino Daza JA. [Multiplane transesophageal echocardiography in the preoperative evaluation of the sinus of Valsalva fistula to right chambers]. Rev Esp Cardiol 2002; 55:29-36. [PMID: 11784521 DOI: 10.1016/s0300-8932(02)76550-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Ruptured sinus of Valsalva aneurysm to right cardiac chambers is an uncommon lesion in Western countries. The prognosis is usually serious unless the condition is promptly treated surgically. For this reason an accurate anatomical and functional evaluation is necessary. The main purpose of this report is to compare the usefulness of multiplane transesophageal echocardiography with transthoracic echocardiography and angiocardiography in the preoperative evaluation of ruptured sinus of Valsalva aneurysm to right chambers. PATIENTS AND METHOD Since January 1990, 9 patients (mean age 36,3 18 yr, 6 males) with ruptured sinus of Valsalva aneurysm to right chambers were studied. The pathogenesis was congenital aneurysm in 6 patients, aortic prosthesis endocarditis in one and two cases of iatrogenia: during a percutaneous mitral valvuloplasty and after cardiac surgery. Transthoracic echocardiography was performed in all cases, transesophageal echocardiography in 7 and angiocardiography in 8. Two patients died before surgery, and 7 were successfully operated on. RESULTS Transesophageal echocardiography was more useful when compared to transthoracic echocardiography and angiocardiography in detecting: a) the fistula; b) the sinus involved; c) the right chamber affected; d) congenital aneurysms morphology and size; e) aneurysm prolapse through a ventricular septal defect, y f) the identification of other cardiac congenital or acquired anomalies. CONCLUSIONS Multiplane TEE is the most accurate tool in the preoperative evaluation of ruptured sinus of Valsalva aneurysm to right chambers.
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Affiliation(s)
- Ana Garrido Martín
- Unidad de Cardiopatías Congénitas del Adulto. Hospital Universitario La Paz. Madrid.
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10
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Yildirir A, Batur MK, Kabakci G. Ruptured aneurysm of the sinus of Valsalva in association with persistent left superior vena cava--a case report. Angiology 2000; 51:167-71. [PMID: 10701726 DOI: 10.1177/000331970005100211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 58-year-old man presenting with chest pain and dyspnea was diagnosed by transesophageal echocardiography and cardiac catheterization to have the rare combination of ruptured aneurysm of noncoronary sinus of Valsalva into the right ventricle in association with persistent left superior vena cava. These defects were confirmed at cardiac surgery. This case shows the importance of complementary use of invasive and noninvasive methods together in the diagnosis of rare combinations of lesions.
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Affiliation(s)
- A Yildirir
- Hacettepe University Department of Cardiology, Ankara, Turkey
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11
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Caputo RP, Rosenberg J, Fedele K, Giambartolomei A. Myocardial ischemia resulting from spontaneous dissection in a patient with massive bilateral sinus of valsalva aneurysms. Catheter Cardiovasc Interv 1999; 47:194-8. [PMID: 10376504 DOI: 10.1002/(sici)1522-726x(199906)47:2<194::aid-ccd15>3.0.co;2-c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We describe a patient with large sinus of Valsalva aneurysms involving both the left and right coronary sinuses. Spontaneous dissection of the left coronary artery occurred, causing unstable angina, a complication heretofore not associated with this disease. Successful surgical reconstruction of the aortic root, aortic valve replacement, and coronary bypass grafting were performed. Pathology revealed cystic medial necrosis.
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Affiliation(s)
- R P Caputo
- Department of Medicine, St Joseph's Hospital, Syracuse, New York 13203, USA
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12
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Bapat VN, Tendolkar AG, Khandeparkar J, Dalvi B, Agrawal N, Kulkarni H, Magotra R. Aneurysms of sinus of Valsalva eroding into the interventricular septum: etiopathology and surgical considerations. Eur J Cardiothorac Surg 1997; 12:759-65. [PMID: 9458148 DOI: 10.1016/s1010-7940(97)00256-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate and discuss etiopathology, clinical manifestations and surgical outcome of a rare subset of unruptured aneurysm of the sinus of Valsalva which erodes into the interventricular septum. METHODS Between 1989 and 1995, seven cases of unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum underwent surgical correction at the King Edward VII Memorial Hospital, Bombay. The origin of all these aneurysms was from the right coronary sinus. The mean age of presentation was 31 years. All patients were male. Calcification of the aneurysm was seen in three. Three patients presented without aortic regurgitation; all had complete heart block. Four patients presented with aortic regurgitation and in addition, two had complete heart block. Preoperative left ventricular function was poor in patients with aortic regurgitation (Ejection fraction range; 30-42%), when compared to those without aortic regurgitation (Ejection fraction range; 48-52%). Of those without aortic regurgitation at initial presentation, one patient developed progressive aortic regurgitation after 3 years requiring surgery. While two other patients were operated at earliest for closure of aneurysm, even in the absence of aortic regurgitation. All those with aortic regurgitation required surgery for aortic valve replacement and closure of aneurysm. Aneurysm was closed by direct suturing of the ostium in two patients and by patch closure in five patients. Permanent pacemaker was implanted in five patients. RESULT There was no operative death. Patients who underwent aortic valve replacement required postoperative ionotropic support. Two patients, who underwent surgery in absence of aortic regurgitation, remain free of aortic regurgitation at the end of 36 and 42 months of follow-up. One of the patients with calcific aneurysmal sac underwent successful re-replacement of the aortic valve for paravalvar leak after a 2 year interval. CONCLUSION Unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum should be operated at the earliest, which makes surgery simple and prevents development of complications such as aortic regurgitation and heart block.
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Affiliation(s)
- V N Bapat
- Department of Cardiovascular and Thoracic Surgery, King Edward VII Memorial Hospital, Parel, Bombay, India.
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13
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Wang KY, St John Sutton M, Ho HY, Ting CT. Congenital sinus of Valsalva aneurysm: a multiplane transesophageal echocardiographic experience. J Am Soc Echocardiogr 1997; 10:956-63. [PMID: 9440073 DOI: 10.1016/s0894-7317(97)80012-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sinus of Valsalva aneurysm is a rare congenital anomaly which, if overlooked, may be associated with increased mortality and morbidity. Multiplane transesophageal echocardiography proved useful in identifying a variety of associated structural heart disease. This study sought to assess the accuracy of the surgical result on the basis of the multiplane transesophageal echocardiography findings and to describe patient demographics and clinical outcome in an Oriental patient cohort. From July 1984 to December 1995, clinical, catheterization, echocardiographic, and surgical results were retrospectively studied in 23 patients with documented sinus of Valsalva aneurysm. Compared with previous reports of Oriental patients, our patient cohort was older (p < 0.025), had more associated aortic, mitral, and tricuspid regurgitation (p < 0.01), but had fewer coexistent ventricular septal defects (p < 0.01), and had more associated coronary artery disease (9%). Multiplane transesophageal echocardiography precisely showed three undiagnosed and/or ambiguous transthoracic echocardiographic studies, and the preoperative transesophageal echocardiography TEE findings were confirmed intraoperatively in the last eight consecutive patients. We concluded that multiplane transesophageal echocardiography provides conclusive information and is the current technique of choice for diagnosis and clinical management of patients with sinus of Valsalva aneurysm; although the natural history of sinus of Valsalva aneurysm remains uncertain, it is likely that the incidence of unruptured sinus of Valsalva aneurysm is considerably higher in the elderly than has been previously reported.
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Affiliation(s)
- K Y Wang
- Division of Cardiology, Taichung Veterans General Hospital, Taiwan
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14
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Lobato EB, Greene MA, Malias MA, Gravenstein N. Intraoperative usefulness of transesophageal echocardiography: detection of unsuspected rupture of an aneurysm of the sinus of Valsalva. J Cardiothorac Vasc Anesth 1997; 11:619-21. [PMID: 9263098 DOI: 10.1016/s1053-0770(97)90017-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- E B Lobato
- Department of Anesthesiology, University of Florida College of Medicine, Gainsville 32610-0254, USA
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15
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Liang CD, Chang JP, Kao CL. Unruptured sinus of Valsalva aneurysm with right ventricular outflow tract obstruction associated with ventricular septal defect. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 37:158-61. [PMID: 8808072 DOI: 10.1002/(sici)1097-0304(199602)37:2<158::aid-ccd11>3.0.co;2-g] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe an aneurysm originating from the right sinus of Valsalva, with right ventricular outflow tract obstruction associated with ventricular septal defect, in a 9-year-old boy. Diagnosis was made by echocardiography and cardiac catheterization. Successful surgical repair of ventricular septal defect and aortic valvuloplasty resulted in symptomatic improvement.
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Affiliation(s)
- C D Liang
- Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
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16
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Abstract
This study evaluated the efficacy of a comprehensive transthoracic Doppler echocardiographic examination for correct detection of SVA and its associated lesions of VSD and aortic insufficiency. A consecutive series of 36 patients was obtained; all had surgical confirmation of the anatomic defects. The location of the SVA was correctly determined in 97% of patients, and the associated presence of a VSD was correctly determined in 79% of the studies. In the cases in which Doppler was available, all 11 patients with associated aortic insufficiency were detected. In this series 32 patients had right SVA, 3 had noncoronary sinus SVA, and 1 had a left SVA. Relative frequency of the rupture site location corresponded closely to that in previous necropsy studies. It is concluded that transthoracic Doppler echocardiography can correctly localize SVAs and most associated lesions.
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Affiliation(s)
- Q Xu
- First Affiliated Hospital, Zhejiang Medical University, People's Republic of China
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17
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MAXTED WILLIAM, SANYAL RAJATSUBHRA, NANDA NAVINC, KIM KEESIK, ROYCHOUDHURY DEBASISH, FINCH ANA, HOLMAN WILLIAM. Transesophageal Echocardiographic Detection of Sinus of Valsalva Dissection. Echocardiography 1995. [DOI: 10.1111/j.1540-8175.1995.tb00527.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Samaha FF, Lang R, Abbo KM, Carroll JD, Weinert L, Follman DF. Intracardiac ultrasonographic imaging to diagnose a ruptured sinus of Valsalva aneurysm. Am Heart J 1994; 128:409-12. [PMID: 8037110 DOI: 10.1016/0002-8703(94)90496-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- F F Samaha
- Hans Hecht Hemodynamics Laboratory, University of Chicago Medical Center, IL 60637-6063
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19
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Dev V, Goswami KC, Shrivastava S, Bahl VK, Saxena A. Echocardiographic diagnosis of aneurysm of the sinus of Valsalva. Am Heart J 1993; 126:930-6. [PMID: 8213452 DOI: 10.1016/0002-8703(93)90709-i] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Echocardiographic and Doppler data of 62 patients with ASOV are presented. Catheterization and angiography were performed in 38 cases and surgery in 25 of the 38. The origin of these aneurysms was the RCS in 56 cases, NCS in 5, and LCS in 1 case. Seven had unruptured aneurysms, 6 rising from RCS dissected into the ventricular septum, producing heart block in 4, AR in 5, mitral regurgitation in 1; 1 aneurysm rising from the LCS was asymptomatic. In other cases (n = 55) the aneurysm had ruptured into one of the cardiac chambers. Thirty-two of the 50 RCS aneurysms ruptured into the RVOT, 13 into the RV cavity, 2 into the RA, and 3 into the LV. Of the 5 NCS aneurysms, (3 ruptured into the RA, 1 into the RV, and 1 into both the RA and RV. Associated VSD was identified in 16 (25.8%) of 62 cases. All of these patients had RCS aneurysms that ruptured into the RVOT. Echocardiography missed VSD in three cases that at surgery were found to have VSD. AR was found in 34 of 62 cases. Echocardiography picked up discrete subaortic stenosis in two cases but missed subvalvar PS in 2 of the 3 cases. A detailed echocardiographic study (two-dimensional, Doppler, and color flow imaging) is accurate in the diagnosis of ASOV, in the identification of its site of origin and rupture, and in the evaluation of the associated defects; in the vast majority of cases, it can totally supplant the need for angiography.
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Affiliation(s)
- V Dev
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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20
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Yanase O, Motomiya T, Nomura S, Tejima T, Maemura T, Sugiura M. Flail tricuspid valve in ruptured aneurysm of the right sinus of Valsalva. Am Heart J 1993; 126:747-9. [PMID: 8362746 DOI: 10.1016/0002-8703(93)90441-b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- O Yanase
- Department of Cardiology, Tokyo Metropolitan Hiroo General Hospital, Japan
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21
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Thomas MR, Monaghan MJ, Michalis LK, Jewitt DE. Aortoatrial fistulae diagnosed by transthoracic and transesophageal echocardiography: advantages of the transesophageal approach. J Am Soc Echocardiogr 1993; 6:21-9. [PMID: 8439419 DOI: 10.1016/s0894-7317(14)80252-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Aortoatrial fistulae are uncommon, providing a difficult diagnostic challenge both in the clinical diagnosis and in the choice of an imaging modality that fully delineates the abnormal anatomy and flow patterns. This report describes four cases of aortoatrial fistula resulting from three different underlying causes. The fistula communicated with the right atrium in three cases and the left atrium in one. We also describe the diagnostic information obtained during both transthoracic and transesophageal echocardiography and stress that full detail of the abnormal anatomy and shunting could be obtained only with the transesophageal approach, with its improved image quality of the aortic root. No extra information, other than the coronary anatomy, was obtained during aortography in the two patients who underwent cardiac catheterization. Transesophageal echocardiography should, therefore, be the investigation of choice in patients in whom there is a suspicion of aortoatrial shunting after clinical examination and routine transthoracic studies, and it may avoid the need for invasive investigation in these potentially hemodynamically unstable patients.
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Affiliation(s)
- M R Thomas
- Department of Cardiology, King's College Hospital, London, United Kingdom
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22
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Cabanes L, Garcia E, VanDamme C, Berrebi A, Donzeau-Gouge P, Fouchard J, Guerin F. Aneurysm of the noncoronary sinus of Valsalva ruptured into the left atrium. Am Heart J 1992; 124:1659-61. [PMID: 1462941 DOI: 10.1016/0002-8703(92)90100-a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- L Cabanes
- Department of Cardiology, Hopital Cochin, René Descartes University, Paris, France
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23
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Humphreys JD, Ballerio FO, Davolos DG. Unruptured sinus of valsalva aneurysm and bicuspid aortic valve with aortic cusp perforation: detection by color flow Doppler mapping. J Am Soc Echocardiogr 1992; 5:631-4. [PMID: 1466889 DOI: 10.1016/s0894-7317(14)80330-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Congestive heart failure developed in a 53-year-old man with a history of bicuspid aortic valve, angina, and pericarditis. Two-dimensional echocardiography showed a sinus of Valsalva aneurysm related to the anterior coronary sinus and color flow mapping identified a perforation of the anterior aortic cusp. These findings were confirmed during surgery.
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Affiliation(s)
- J D Humphreys
- Department of Cardiology, Hospital Britanico, Buenos Aires, Argentina
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24
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Sundar AS, Fox KA. Anomalous origin of the right coronary artery from the pulmonary artery in association with congenital aneurysm of the sinus of Valsalva: angiographic diagnosis of a rare association. BRITISH HEART JOURNAL 1992; 68:330-2. [PMID: 1389769 PMCID: PMC1025082 DOI: 10.1136/hrt.68.9.330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 37 year old man presenting with acute heart failure, hypotension, and acute renal failure was diagnosed by cardiac catheterisation and angiography to have the rare combination of congenital aneurysm of the non-coronary sinus of Valsalva rupturing into the right ventricle, and an anomalous origin of the right coronary artery from the main pulmonary artery. The diagnosis could not be confirmed by transthoracic echocardiography in this patient. This combination of defects, confirmed at cardiac surgery, has not been reported before, and this case report highlights the importance of preoperative definition of congenital defects associated with an aneurysm of the sinus of Valsalva.
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Affiliation(s)
- A S Sundar
- Department of Cardiology, University of Wales College of Medicine, Heath Park, Cardiff
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25
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Rubin DC, Carliner NH, Salter DR, Plotnick GD, Hawke MW. Unruptured sinus of Valsalva aneurysm diagnosed by transesophageal echocardiography. Am Heart J 1992; 124:225-7. [PMID: 1615814 DOI: 10.1016/0002-8703(92)90949-v] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- D C Rubin
- Department of Medicine, University of Maryland Medical Center, Baltimore 21201
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26
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Lester GD, Lombard CW, Ackerman N. ECHOCARDIOGRAPHIC DETECTION OF A DISSECTING AORTIC ROOT ANEURYSM IN A THOROUGHBRED STALLION. Vet Radiol Ultrasound 1992. [DOI: 10.1111/j.1740-8261.1992.tb00134.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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27
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Affiliation(s)
- P A McKenney
- Evans Memorial Department of Clinical Research, Boston, MA
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28
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Blackshear JL, Safford RE, Lane GE, Freeman WK, Schaff HV. Unruptured noncoronary sinus of Valsalva aneurysm: preoperative characterization by transesophageal echocardiography. J Am Soc Echocardiogr 1991; 4:485-90. [PMID: 1742036 DOI: 10.1016/s0894-7317(14)80382-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We describe a patient with a large unruptured sinus of Valsalva aneurysm that was discovered incidentally. Transesophageal echocardiography was used to characterize the aneurysm preoperatively, and was helpful intraoperatively in assessment of the degree of native aortic valvular regurgitation after repair. The use of transthoracic echocardiography, contrast echocardiography, Doppler echocardiography, and transesophageal echocardiography are discussed in this condition.
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Affiliation(s)
- J L Blackshear
- Section of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224
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29
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Katz ES, Cziner DG, Rosenzweig BP, Attubato M, Feit F, Kronzon I. Multifaceted echocardiographic approach to the diagnosis of a ruptured sinus of Valsalva aneurysm. J Am Soc Echocardiogr 1991; 4:494-8. [PMID: 1742038 DOI: 10.1016/s0894-7317(14)80384-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- E S Katz
- Department of Medicine, New York University Medical Center
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30
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Sahasakul Y, Panchavinnin P, Chaithiraphan S, Sakiyalak P. Echocardiographic diagnosis of a ruptured aneurysm of the sinus of Valsalva: operation without catheterisation in seven patients. Heart 1990; 64:195-8. [PMID: 2206711 PMCID: PMC1024371 DOI: 10.1136/hrt.64.3.195] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A ruptured aneurysm of the sinus of Valsalva was diagnosed by Doppler, colour, and cross sectional echocardiography in a consecutive series of seven patients. The diagnoses were confirmed at operation without cardiac catheterisation. Examination by pulsed and continuous Doppler echocardiography showed continuous turbulence in six patients with aneurysms rupturing into the right ventricular outflow tract and in the patient with rupture of an aneurysm of the non-coronary sinus into the right atrium. Colour Doppler echocardiography showed turbulent flow across the defects in all seven patients. A ventricular septal defect with aortic regurgitation was detected in one patient and an associated ventricular septal defect in another. Doppler, colour, and cross sectional echocardiography were useful non-invasive techniques for diagnosing a ruptured aneurysm of the sinus of Valsalva without the need for cardiac catheterisation.
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Affiliation(s)
- Y Sahasakul
- Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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31
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Abdelkhirane C, Roudaut R, Dallocchio M. Diagnosis of ruptured sinus of Valsalva aneurysms: potential value of transesophageal echocardiography. Echocardiography 1990; 7:555-60. [PMID: 10149235 DOI: 10.1111/j.1540-8175.1990.tb00400.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Two patient cases are reported in which an aneurysm of the right coronary sinus of Valsalva ruptured into the right ventricular outflow tract, near the crux of the heart. Transthoracic two-dimensional echocardiography and transesophageal echocardiography using Doppler color flow mapping allowed accurate preoperative assessment of the left-to-right shunt, which was subsequently confirmed by contrast aortography and surgery.
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Affiliation(s)
- C Abdelkhirane
- Department of Medical Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
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32
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Goldberg N, Zisbrod Z, Kipperman R, Krasnow N, Gordon D, Shapir Y, Stein R. Congenital aneurysm of the left coronary sinus and left main coronary artery with fistulous communication to the right atrium in pregnancy. J Am Soc Echocardiogr 1990; 3:125-30. [PMID: 2334541 DOI: 10.1016/s0894-7317(14)80505-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We describe a unique case of a left coronary arteriovenous fistula arising from a left sinus of Valsalva aneurysm in a pregnant woman. The relevant diagnostic contributions of two-dimensional echocardiography, color flow Doppler, magnetic resonance imaging, and angiography are discussed. The hemodynamic manifestations of this anomaly in pregnancy and the eventual surgical correction are reviewed.
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Affiliation(s)
- N Goldberg
- State University of New York Health Sciences Center, Brooklyn
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33
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JAIN SURESHP, MAHAN EDWARDF, NANDA NAVINC, SERGE BAROLD S, WILLIS JAMESE, PINHEIRO LUIZ. Doppler Color Flow Mapping in the Diagnosis of Sinus of Valsalva Aneurysm. Echocardiography 1989. [DOI: 10.1111/j.1540-8175.1989.tb00337.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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