Fixed subaortic stenosis with congenital aneurysm of sinus of Valsalva--cross-sectional and Doppler echocardiographic diagnosis of a rare association

Echocardiographic diagnosis of aneurysm of the sinus of Valsalva

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.

Cross-sectional echocardiographic diagnosis of discrete subaortic stenosis, ruptured congenital aneurysm of the right sinus of Valsalva, unruptured aneurysm of non-coronary sinus and a rudimentary left aortic leaflet

A 7-year-old asymptomatic male child was found to have a shelf-like subaortic stenosis, congenital aneurysm of the right sinus of Valsalva communicating with the right ventricular outflow tract, an unruptured aneurysm of the non-coronary sinus and a small left aortic sinus with a rudimentary valvar leaflet causing moderate aortic regurgitation. The diagnosis was made by cross-sectional and Doppler echocardiography and confirmed by cineangiocardiography.