Dissection of the interventricular septum by unruptured right and left sinus of Valsalva aneurysms

Aneurysm of sinus of Valsalva dissecting into interventricular septum

BACKGROUND

Dissection of interventricular septum by aneurysm of the sinus of Valsalva is extremely rare. We present our experience with the management of 10 patients with this condition.

METHODS

Ten patients with aneurysm of the sinus of Valsalva dissecting into the interventricular septum were managed at All India Institute of Medical Sciences, New Delhi, between May 1987 and September 1996. Conduction abnormalities and aortic insufficiency dominated the clinical picture. Eight patients underwent surgical repair. Two patients refused operation, and only permanent pacemaker implantation was done for complete heart block in both these patients.

RESULTS

There was no hospital mortality. Follow-up ranged from 1 to 9 years. There was one late death due to carcinoma of the larynx, and 1 patient required reoperation for persistent aortic insufficiency. All other patients who underwent operation are in New York Heart Association functional class I.

CONCLUSIONS

We recommend surgical repair of this condition to deal with aortic regurgitation and to avoid the potential risk of rupture, thromboembolism, and infective endocarditis. However, surgical repair offers no guarantee against arrhythmias and conduction abnormalities.

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.