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Bansal RC, Ali S, Prasad V, Razzouk A, Ghatnekar N, Floridia R. Extrinsic Circumflex Coronary Artery Compression and Occlusion by Mycotic Aneurysm of Left Aortic Sinus. CASE 2022; 6:158-164. [PMID: 35818485 PMCID: PMC9270671 DOI: 10.1016/j.case.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mycotic aneurysm of the aortic sinus is a rare complication of aortic valve endocarditis. Mycotic aneurysm of left sinus causing LM compression and circumflex occlusion is shown. We present TTE and TEE approaches to making the diagnosis of this complex lesion. Sketches of complications of aortic valve endocarditis are presented.
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Pólos M, Șulea CM, Benke K, Ágg B, Kovács A, Hartyánszky I, Merkely B, Schäfers HJ, Szabolcs Z. Giant unruptured sinus of Valsalva aneurysm successfully managed with valve-sparing procedure - a case report. J Cardiothorac Surg 2020; 15:6. [PMID: 31915041 PMCID: PMC6950913 DOI: 10.1186/s13019-020-1061-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, with an incidence of less than 1% of open heart surgery cases. Its evolution is most frequently silent, being found incidentally or discovered in the event of its acute rupture. Non-ruptured giant SVAs may cause unusual clinical manifestations, as a consequence of their protrusion into the heart chambers or compression of the coronary vessels and are frequently associated with aortic insufficiency of various degrees of severity. The gold standard treatment for SVAs consists of complete replacement of the aortic root and valve. However, in certain cases, valve-sparing procedures may prove to be a more suitable alternative. Case presentation A 68-year-old male patient presented with dyspnea as symptom caused by a large (> 5 cm) right sinus of Valsalva aneurysm. The aneurysm was occupying most of the right ventricle and was associated with severe aortic regurgitation. The surgical treatment of the condition involved valve-sparing root reconstruction procedure (remodeling technique), completed with external stabilization of the aortic valve annulus via running suture annuloplasty. Following the uneventful intervention, the patient did well and his status improved. The follow-up transthoracic echocardiography obtained 1 month after surgery showed a fully competent aortic valve with no regurgitation. Conclusions Despite complete aortic root and valve replacement being considered the safest approach to large SVAs complicated with aortic insufficiency, valve-sparing procedures should not be overlooked in case of a dilated aortic root with uncalcified aortic valve. Performing valve-sparing by applying a remodeling technique operation completed with annuloplasty reduces aortic valve insufficiency, avoiding side-effects related to implanted valves.
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Affiliation(s)
- Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
| | - Cristina-Maria Șulea
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bence Ágg
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University, Medical Center and Saarland University Faculty of Medicine, Saarbrücken, Germany
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Mørk SR, Eftekhari A, Tang M, Klaaborg KE. Giant unruptured aneurysm of the left coronary sinus of Valsalva presenting as acute coronary syndrome: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5476576. [PMID: 31449599 PMCID: PMC6601242 DOI: 10.1093/ehjcr/ytz053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/03/2019] [Indexed: 11/25/2022]
Abstract
Background Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that can be congenital or acquired. Unruptured aneurysms may be asymptomatic but can present as malignant arrhythmias, acute chest pain, and even sudden cardiac death. Both ruptured and unruptured SVAs may have fatal complications, thus prompt diagnosis and surgery is critical. Case summary We report a successful surgical repair of an unruptured aneurysm of the left sinus of Valsalva presenting as acute coronary syndrome. Coronary angiography (CAG) and cardiac multislice computed tomography (CT) revealed a large unruptured aneurysm of the left sinus of Valsalva. Surgical repair was performed by resection of the aneurysm, aortic valve replacement with composite graft, and coronary artery bypass. Discussion Aneurysm of the left sinus of Valsalva is an extremely rare condition. Correct diagnosis can be done by echocardiography, CAG, or CT. Non-ruptured aneurysms should be surgically repaired if they are associated with significant symptoms or if their size enlarge rapidly.
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Affiliation(s)
- Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark
| | - Mariann Tang
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark
| | - Kaj-Erik Klaaborg
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark
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Seo KW, Park JS. Sinus of Valsalva Aneurysm and Multiple Aortic Aneurysms Provoked by Viral Myocarditis. Korean Circ J 2019; 49:194-196. [PMID: 30693683 PMCID: PMC6351280 DOI: 10.4070/kcj.2018.0309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kyoung Woo Seo
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Jin Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
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Giambruno V, Cucchietti C, Pisano C, Hyde J. Alternative Surgical Approach to Repairing a Giant Sinus of Valsalva Aneurysm. Tex Heart Inst J 2016; 43:43-4; discussion 44-5. [PMID: 27047284 DOI: 10.14503/thij-15-5108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report our method of surgically repairing an unruptured giant aneurysm of the right coronary sinus of Valsalva, a lesion that caused moderate aortic regurgitation but no symptoms in a 61-year-old woman. We excised the aneurysm, reconstructed the right sinus of Valsalva with use of a patch, performed mechanical aortic valve replacement directly through the excised aneurysm's cavity, and constructed a single bypass graft to the right coronary artery. The patient was discharged from the hospital after 5 days. Twelve months postoperatively, her clinical and echocardiographic results were normal, and she was doing well. To our knowledge, our surgical approach to this repair has not been described previously.
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Nakajima M, Abe A, Nishiyama Y, Harada-Abe M, Kutsuna A, Goto Y, Okubo S, Mishina M, Katsura KI, Katayama Y. Multiple Vascular Accidents Including Rupture of a Sinus of Valsalva Aneurysm, a Minor Ischemic Stroke and Intracranial Arterial Anomaly in a Patient with Systemic Congenital Abnormalities: A Case Report. Case Rep Neurol 2013; 5:195-200. [PMID: 24348399 PMCID: PMC3843907 DOI: 10.1159/000356292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 39-year-old man with a history of rupture of a sinus of Valsalva aneurysm experienced an ischemic stroke. Although the patient presented left-sided hemiparesis for a week, no abnormal signals were indicated on diffusion-weighted imaging with repeated magnetic resonance scans. Carotid ultrasound and cerebral angiography were conducted, and they revealed hypoplasty of the left internal carotid artery with a low-lying carotid bifurcation at the level of the C6 vertebra. In addition, he was diagnosed with intellectual disabilities, evaluated by the Wechsler Adult Intelligence Scale-III, and congenital velopharyngeal insufficiency. We herein present the first report of a patient with cardio-cerebrovascular abnormalities, intellectual disabilities, and an otorhinolaryngological abnormality.
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Affiliation(s)
| | | | - Yasuhiro Nishiyama
- *Yasuhiro Nishiyama, MD, PhD, Division of Neurology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602 (Japan)), E-Mail
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A rare cause of dyspnea: sudden rupture of aortic valsalva sinus aneurysm. Case Rep Med 2013; 2013:909302. [PMID: 23533439 PMCID: PMC3600221 DOI: 10.1155/2013/909302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/20/2012] [Accepted: 02/03/2013] [Indexed: 11/22/2022] Open
Abstract
Aneurysm of the sinus of Valsalva is an uncommon cardiac abnormality; however, the most common complication is rupture into the right heart chambers or rarely towards the left chambers. A ruptured aneurysm typically leads to an aortocardiac shunt and progressively worsening heart failure. We report a case of a 21-year-old male who suffered an aneurysm of the sinus of Valsalva rupture into the right atrium who underwent successful surgical repair.
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Troupis JM, Nasis A, Pasricha S, Patel M, Ellims AH, Seneviratne S. Sinus valsalva aneurysm on cardiac CT angiography: Assessment and detection. J Med Imaging Radiat Oncol 2012; 57:444-7. [DOI: 10.1111/j.1754-9485.2012.02467.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 07/19/2012] [Indexed: 11/27/2022]
Affiliation(s)
- John M Troupis
- Diagnostic Imaging; Monash Medical Centre; Southern Health; Melbourne; Victoria; Australia
| | - Arthur Nasis
- Monash Cardiovascular Research Centre, Monash Heart; Southern Health; Melbourne; Victoria; Australia
| | - Sundeep Pasricha
- Diagnostic Imaging; Monash Medical Centre; Southern Health; Melbourne; Victoria; Australia
| | - Mihir Patel
- Diagnostic Imaging; Monash Medical Centre; Southern Health; Melbourne; Victoria; Australia
| | - Andris Harald Ellims
- Department of Cardiovascular Medicine; Alfred Hospital; Prahran; Victoria; Australia
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Huh SJ, Park TH, Lee DY, Kang H, Kim BS, Cho YR, Kim MH, Kim YD, Lee SM. A giant unruptured right coronary sinus of valsalva aneurysm. J Cardiovasc Ultrasound 2012; 20:60-2. [PMID: 22509442 PMCID: PMC3324731 DOI: 10.4250/jcu.2012.20.1.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/05/2012] [Accepted: 02/16/2012] [Indexed: 11/22/2022] Open
Abstract
There have been few case reports on giant sinus of Valsalva aneurysm (SVA). We report a case of a giant unruptured right coronary SVA that was confused with a pericardial cyst by transthoracic echocardiography.
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Affiliation(s)
- Seok-Jae Huh
- Department of Cardiology, Dong-A University College of Medicine, Busan, Korea
| | - Tae-Ho Park
- Department of Cardiology, Dong-A University College of Medicine, Busan, Korea
| | - Dong-Yeol Lee
- Department of Cardiology, Dong-A University College of Medicine, Busan, Korea
| | - Hyojin Kang
- Department of Cardiology, Dong-A University College of Medicine, Busan, Korea
| | - Bo-Sung Kim
- Department of Cardiology, Dong-A University College of Medicine, Busan, Korea
| | - Yong-Rack Cho
- Department of Cardiology, Dong-A University College of Medicine, Busan, Korea
| | - Moo-Hyun Kim
- Department of Cardiology, Dong-A University College of Medicine, Busan, Korea
| | - Young-Dae Kim
- Department of Cardiology, Dong-A University College of Medicine, Busan, Korea
| | - Sun-Mi Lee
- Department of Family Medicine, Dong-A University College of Medicine, Busan, Korea
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Abstract
Body and earlobe piercing are common practices in the USA today. Minor complications including infection and bleeding occur frequently and, although rare, major complications have been reported. Healthcare professionals should be cognizant of the medical consequences of body piercing. Complications vary depending on the body-piercing site, materials used, experience of the practitioner, hygiene regimens, and aftercare by the recipient. Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation. Site-specific complications have been reported. Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal. Piercing tracts in the ear, nipple, and navel are prone to tearing. Galactorrhea may be caused by stimulation from a nipple piercing. Genital piercings may lead to infertility secondary to infection, and obstruction of the urethra secondary to scar formation. In men, priapism and fistula formation may occur. Women who are pregnant or breastfeeding and have a piercing or are considering obtaining one need to be aware of the rare complications that may affect them or their child. Though not a 'complication' per se, many studies have reported body piercing as a marker for high-risk behavior, psychopathologic symptoms, and anti-social personality traits. When it comes to piercing complications, prevention is the key. Body piercers should take a complete medical and social history to identify conditions that may predispose an individual to complications, and candidates should choose a qualified practitioner to perform their piercing. As body piercing continues to be popular, understanding the risks of the procedures as well as the medical and psychosocial implications of wearing piercing jewelry is important for the medical practitioner.
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Affiliation(s)
- Jaimee Holbrook
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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The role of multi-modality imaging for sinus of Valsalva aneurysms. Int J Cardiovasc Imaging 2012; 28:1725-38. [DOI: 10.1007/s10554-011-0001-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
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Bacterial infections complicating tongue piercing. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 21:e70-4. [PMID: 21358880 DOI: 10.1155/2010/987059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tongue piercing has become an increasingly popular form of body art. However, this procedure can occasionally be complicated by serious bacterial infections. The present article reports a case of prosthetic valve endocarditis caused by a Gemella species in a patient with a pierced tongue, and reviews 18 additional cases of local and systemic bacterial infections associated with tongue piercing. Infections localized to the oral cavity and head and neck region included molar abscess, glossal abscess, glossitis, submandibular lymphadenitis, submandibular sialadenitis, Ludwig's angina and cephalic tetanus. Infections distal to the piercing site included eight cases of infective endocarditis, one case of chorioamnionitis and one case of cerebellar abscess. Oropharyngeal flora were isolated from all cases. While bacterial infections following tongue piercing are rare, there are reports of potentially life-threatening infections associated with the procedure. Both piercers and their clients should be aware of these potential complications, and standardized infection prevention and control practices should be adopted by piercers to reduce the risk.
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Infective endocarditis after body art: a review of the literature and concerns. J Adolesc Health 2008; 43:217-25. [PMID: 18710675 DOI: 10.1016/j.jadohealth.2008.02.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Revised: 01/18/2008] [Accepted: 02/09/2008] [Indexed: 11/21/2022]
Abstract
PURPOSE Infective endocarditis (IE) is a rare but dangerous complication of tattooing and body piercing in adolescents and young adults 15-30 years of age, with and without congenital heart disease (CHD). Because body art, including tattooing and piercing, is increasing and IE cases continue to be reported in the literature, a longitudinal assessment of IE and body art cases is important to examine for trends. METHODS A 22-year (1985-2007) longitudinal electronic Medline and Scopus review of all published cases of IE and body art was conducted. RESULTS In all, 22 specific cases of IE spanning 1991-2007 have been reported that were associated with piercing the tongue (seven), ear lobes (six), navel (five), lip (one), nose (one), and nipple (one), and reported in one heavily tattooed person; other general IE cases have also been mentioned. Twelve cases were in females, and one patient died; nine of these individuals had CHD. Twenty-one cases have been published in the 10 years from 1997-2007. CONCLUSIONS Although there is no denominator to assess the real risk, this review provides more evidence of IE and body art concerns, and should stimulate further discussion regarding IE antibiotic prophylaxis. It is believed that IE is triggered by normal flora at the body art site, microorganism colonization around the jewelry, or by a localized site infection that stimulates episodes of transient bacteremia (commonly caused by staphylococi) and then seeds various areas of the heart. Frequently in such cases the mitral or aortic valves need to be replaced. For individuals with CHD who want body art, prophylactic antibiotic regimens have been suggested since 1999. Millions of tattoos and body piercings are done yearly, and more IE cases are therefore suspected. An international electronic repository of body art complications would provide better documentation. Body art procurement for many persons in this age group is a matter of "when, not if"; thus proactive, frequent, targeted educational strategies for adolescents and artists practicing body art are suggested.
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Fujii T, Sumiyoshi S, Koga T, Nishizaka M, Matsukawa R, Kuwano H, Sueishi K. An autopsy case report of annuloaortic ectasia with cardiac tamponade ruptured from an aneurysm of the right Valsalva sinus. Pathol Res Pract 2007; 203:671-5. [PMID: 17646055 DOI: 10.1016/j.prp.2007.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 04/26/2007] [Accepted: 05/02/2007] [Indexed: 11/20/2022]
Abstract
Annuloaortic ectasia (AAE) is a clinicopathologic condition with primary or secondary dilatation of the aortic annulus and aneurysm of the proximal thoracic aorta, leading to aortic regurgitation. We herein report an autopsy case of a Japanese 57-year-old male with AAE who died of a cardiac tamponade rupture from the sinus of the right coronary. The wall of the aortic root, particularly that of the sinus of the right coronary Valsalva, underwent extensive fibrosis with loss or fragmentation of the elastic lamina in the medial layer and perforation directly into the pericardial space. The adventitia of the proximal aorta to the aortic arch was diffusely fibrotic with both acute and chronic hemorrhage and chronic inflammatory infiltrate. However, the ascending aortic media was largely intact, except for focal laminar necrosis at the center of the medial layer; no medial cystic necrosis, laminar necrosis, or mesoaortitis/panaortitis was present in the thoracic or abdominal aorta, nor in the main aortic branches, which was suggestive of Takayasu disease and giant cell arteritis. Thus, this patient was diagnosed to have idiopathic AAE with sustained peri-aortic hemorrhage, and he finally died of a cardiac tamponade resulting from an aneurysmal rupture.
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Affiliation(s)
- Takaaki Fujii
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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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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