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Temel Dağ M, Buğra A, Buğra AK. Sudden Death Due to Rupture of Aneurysm of Sinus Valsalva: An Autopsy Case. Am J Forensic Med Pathol 2024; 45:274-276. [PMID: 38323837 DOI: 10.1097/paf.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
ABSTRACT Aneurysm of sinus Valsalva is a defined as dilatation of the sinuses located between the aortic valve annulus and the sinotubular junction and mostly found in the right coronary sinus. It can be either congenital or acquired. This condition is usually asymptomatic unless it can cause intracardiac rupture or aortic valve insufficiency. Extracardiac rupture and associated fatal cases of cardiac tamponade are extremely rare. Our case is one of the rare cases in the literature that was diagnosed during autopsy. Our case is 65-year-old male patient with a history of hypertension suddenly fell ill after swimming in the sea. On gross examination of heart, there was an aneurysmatic enlargement of the right sinus Valsalva measuring 4.5 × 4 cm with a hemorrhagic appearance on the outer surface and a 0.3 cm rupture area. Histopathological examination revealed hemorrhage in and around the aneurysm wall.
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Affiliation(s)
- Merve Temel Dağ
- From the Morgue Department, Council of Forensic Medicine, Istanbul, Turkey
| | - Aytül Buğra
- From the Morgue Department, Council of Forensic Medicine, Istanbul, Turkey
| | - Abdul Kerim Buğra
- Department of Cardiovascular Surgery, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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2
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Togashi K, Paez FJG, Sheu RD. Sinus of Valsalva Aneurysm Rupture Associated With a Ventricular Septal Defect: The Importance of Multi-Angle Assessment by Intraoperative Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2020; 34:3376-3381. [PMID: 32800621 DOI: 10.1053/j.jvca.2020.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Kei Togashi
- Department of Anesthesiology and Perioperative Care, University of California Irvine, CA.
| | - Francisco J Gensini Paez
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Richard D Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
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3
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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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4
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Drummer EM, Hobbs RE, Fitzgerald R, Moodie DS. Aneurysm of the Aortic Sinuses of Valsalva: Hemodynamics and Long-Term Prognosis After Surgery. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857448401800503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Seventeen patients with sinus of Valsalva aneurysm are described. All of these patients have had late follow-up to assess prognosis. Twelve patients had congenital aneurysms and five were mycotic. There were 12 males and five females, ranging in age from 20 to 59 years of age (mean of 38 years). Symp toms of congestive heart failure, fatigue, and palpitations were common and were present from three days to seven years before diagnosis (mean of 13.8 months.) All patients had cardiac catheterization including aortography, and 16 had right heart catheterizations. Eleven patients (65%) had aneurysms which ruptured into another cardiac chamber, most frequently the right atrium (six patients). Eleven patients (65%) had aortic insufficiency, and it was moderate to severe in seven. New York Heart Association (NYHA) Functional Class at diag nosis was variable and did not correlate with degree of left-to-right shunt in patients with fistulas to the right heart. Functional Class seemed to correlate with the degree of aortic insufficiency. Fourteen patients required surgery. The surgical procedure usually con sisted of repair of aneurysm and fistula when present, and aortic valve replace ment. There was one death prior to surgery and one operative death (operative mortality of 7%). Ten of the patients (66%) were in NYHA Functional Class I at late follow-up (range 2.5 to 13.1 years, mean 6.5 years). Long-term functional disability occurred more frequently in patients with moderate to severe aortic insufficiency at the time of diagnosis. Patients with aneurysm of the sinus of Valsalva are a heterogenous popula tion. Functional Class at the time of diagnosis as well as long-term prognosis appears to be related to the presence and severity of aortic insufficiency at diagnosis. Catheterization with aortography and right heart catheterization are mandatory for accurate diagnosis. Surgical results are good with low operative mortality and improvement in long-term Functional Class.
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Affiliation(s)
- Eric M. Drummer
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert E. Hobbs
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rita Fitzgerald
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Douglas S. Moodie
- Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland, Ohio 44106
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5
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Kim HR, Kim SJ, Lim KH, Kim JM, Lee JH, Kim YG, Jung JP, Lee SG. A Case of Perimembranous Ventricular Septal Defect Associated with Sinus of Valsalva Aneurysm Mimicking Membranous Septal Aneurysm. J Cardiovasc Ultrasound 2015; 23:113-7. [PMID: 26140155 PMCID: PMC4486176 DOI: 10.4250/jcu.2015.23.2.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 04/15/2015] [Accepted: 05/19/2015] [Indexed: 11/22/2022] Open
Abstract
Sinus of Valsalva aneurysms are rare. Sinus of Valsalva aneurysms are frequently associated with ventricular septal defect (VSD) and aortic regurgitation. They often remain asymptomatic until abruptly presenting with acute chest pain and heart failure secondary to rupture. Here, we describe a case of 20-year-old man who presented with chest pain with a history of VSD. Initial work-up concluded that the patient had VSD associated membranous septal aneurysm. Four years later, the patient presented with symptoms of heart failure. Work-up showed that the ruptured sinus of Valsalva aneurysm was the cause of symptoms. Due to its close proximity to the aortic annulus, sinus of Valsalva aneurysm should be differentiated from membranous septal aneurysm.
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Affiliation(s)
- Hyung Rae Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Shin-Jae Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyoung Hoon Lim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Min Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Ho Lee
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yong-Giun Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong-Pil Jung
- Department of Cardiac Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang-Gon Lee
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Aneurisma del seno de Valsalva roto. Presentación de un caso evaluado con ecocardiografía tridimensional en tiempo real. REVISTA COLOMBIANA DE CARDIOLOGÍA 2011. [DOI: 10.1016/s0120-5633(11)70179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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7
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Kanzaki Y, Terasaki F, Fuji S, Kashiyama T, Kaibe S, Doi Y, Kitaura Y. A sinus of Valsalva-right atrium fistula without aneurysm formation. Intern Med 2010; 49:749-51. [PMID: 20424364 DOI: 10.2169/internalmedicine.49.3089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 61-year-old man was admitted to the hospital because of orthopnea and was diagnosed with heart failure with a continuous heart murmur. A transthoracic echocardiogram revealed turbulent flow from the right coronary sinus of Valsalva to the right atrium throughout the cardiac cycle. Aortography confirmed the presence of a shunt jet from the right coronary sinus of Valsalva to the right atrium. Cardiac catheterization revealed a left-right shunt rate of 47% and a pulmonary to systemic blood flow ratio of 1.81. Transesophageal echocardiography confirmed the existence of the shunt jet and revealed no deformity of the sinus of Valsalva. We report a rare case of sinus of Valsalva-right atrium fistula without typical aneurysmal formation.
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Affiliation(s)
- Yumiko Kanzaki
- Department of Internal Medicine III, Osaka Medical College, Takatsuki.
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8
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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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9
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Abstract
Aneurysms of the sinus of Valsalva (ASVs) are rare. They can be congenital or acquired through infection, trauma, or degenerative diseases. They frequently co-occur with ventricular septal defects, aortic valve dysfunction, or other cardiac abnormalities. Although unruptured ASVs are usually asymptomatic, ruptured ASVs often cause symptoms similar to those of heart failure and produce a continuous, mechanical-sounding murmur. Transsternal or transesophageal echocardiography is usually effective in detecting ASVs. Because symptomatic ASVs pose significant risks for the patient, and because the repair of asymptomatic ASVs generally produces excellent outcomes, surgery is indicated in most cases. The primary goals of surgical repair are to close the ASV securely, remove or obliterate the aneurysmal sac, and repair any associated defects. Operative mortality is generally low except in patients with concomitant bacterial endocarditis or other infections. Late events are uncommon and tend to be related to aortic valve prothesis or Marfan syndrome.
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Affiliation(s)
- David A Ott
- Division of Cardiovascular Surgery, the Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA.
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10
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Lee TH, Lee DW, Cho JY, Hyun MC, Lee SB. Clinical features and surgical results of ruptured sinus of valsalva aneurysm. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.3.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tae Ho Lee
- Department of Pediatrics, College of Medicine, Kyungbook National University, Daegu, Korea
| | - Dong Won Lee
- Department of Pediatrics, College of Medicine, Kyungbook National University, Daegu, Korea
| | - Joon Yong Cho
- Department of Thoracic Cadiovascular Surgery, College of Medicine, Kyungbook National University, Daegu, Korea
| | - Myung Chul Hyun
- Department of Pediatrics, College of Medicine, Kyungbook National University, Daegu, Korea
| | - Sang Bum Lee
- Department of Pediatrics, College of Medicine, Kyungbook National University, Daegu, Korea
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11
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Nishi I, Ishizu T, Sakamoto K, Eda K, Ishimitsu T, Watanabe S, Yamaguchi I. A Case of Sinus of Valsalva-right Ventricle Fistula Without a Typical Aneurysm, and a Single Origin of the Coronary Arteries. Int Heart J 2005; 46:531-6. [PMID: 16043947 DOI: 10.1536/ihj.46.531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Few previous reports have described a sinus of Valsalva fistula without an aneurysm in Japanese patients. A single origin of the coronary arteries is a rare coronary anomaly. We describe a 75-year-old woman with a single origin of the coronary arteries and a sinus of Valsalva fistula without a typical aneurysm. Echocardiography showed turbulent flow from the right coronary sinus of Valsalva to the right ventricle throughout the cardiac cycle. Aortography confirmed the presence of a right coronary sinus of Valsalva-right ventricle shunt jet. Echocardiography and aortography demonstrated that there was no deformity of the sinus of Valsalva. Cardiac catheterization revealed that the left-to-right shunt rate was 29% and the Qp/Qs was 1.41. Aortography and coronary angiography did not identify a right coronary artery originating from the right sinus of Valsalva. Coronary angiography revealed that the right coronary artery arose from the proximal part of the left anterior descending artery and did not detect significant organic stenosis of the coronary artery. She was diagnosed as having a sinus of Valsalva to right ventricle fistula without an aneurysm, and a single origin of the coronary arteries.
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Affiliation(s)
- Isao Nishi
- Department of Cardiology, Mito Chuou Hospital, Ibaraki, Japan
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12
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Abstract
BACKGROUND In order to understand the long-term outcome after surgical repair of sinus of Valsalva aneurysms or fistulas (SVAF), the operative results for patients treated at Shanghai Chest Hospital were retrospectively assessed. METHODS Between 1960 and 1999, 216 patients were operated on for SVAF. Of these 143 (66.2%) had a ventricular septal defect (VSD), 60 (28.0%) had aortic regurgitation and of these 12 underwent aortic valve replacement (AVR). RESULTS There were eight in-hospital deaths (3.7%). Another patient had aortic regurgitation postoperatively requiring AVR. CONCLUSION Resection and repair of SVAF entails an acceptably low operative risk and yields long-term freedom from symptoms. Early, aggressive operation is recommended to prevent development of complications.
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Affiliation(s)
- Feng Li
- Shanghai Chest Hospital, Shanghai, China.
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13
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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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Choudhary SK, Airan B, Bhan A, SampathKumar A, Sharma R, Talwar S, Venugopal P. Aneurysms of the sinus of Valsalva: Morphology and long term surgical results. Indian J Thorac Cardiovasc Surg 2000. [DOI: 10.1007/s12055-000-0019-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Takach TJ, Reul GJ, Duncan JM, Cooley DA, Livesay JJ, Ott DA, Frazier OH. Sinus of Valsalva aneurysm or fistula: management and outcome. Ann Thorac Surg 1999; 68:1573-7. [PMID: 10585023 DOI: 10.1016/s0003-4975(99)01045-0] [Citation(s) in RCA: 202] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Few large or long-term series exist regarding the management of patients with sinus of Valsalva aneurysms or fistulas (SVAFs). METHODS Between 1956 and 1997, 129 patients presented with a ruptured (64 cases; 49.6%) or nonruptured (65 cases; 50.4%) SVAF. The patients included 88 men and 41 women, with a mean age of 39.1 years. Associated findings included a history of endocarditis (42 cases; 32.6%), a bicuspid aortic valve (21 cases; 16.3%), a ventricular septal defect (15 cases; 11.6%), and Marfan's syndrome (12 cases; 9.3%). Operative procedures included simple plication (61 cases; 47.3%), patch repair (52 cases; 40.3%), aortic root replacement (16 cases; 12.4%), and aortic valve replacement/repair (75 cases; 58.1%). RESULTS There were five in-hospital deaths (3.9%): four due to preexisting sepsis and endocarditis and one that followed dehiscence of the repair in a patient with Marfan's syndrome. Two patients (1.6%) had strokes during the early postoperative period. The survivors were followed up for 661.1 patient-years (5.3 years/patient). The following late complications occurred: prosthetic valve malfunction (5 cases; 3.9%), prosthetic valve endocarditis (3 cases; 2.3%), SVAF recurrence (2 cases; 1.6%), thrombosis (1 case; 0.8%), and anticoagulation-related bleeding (1 case; 0.8%). CONCLUSIONS Resection and repair of SVAF entails an acceptably low operative risk and yields long-term freedom from symptoms. Early, aggressive treatment is recommended to prevent endocarditis or lesional enlargement, which causes worse symptoms and necessitates more extensive repair.
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Affiliation(s)
- T J Takach
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston 77225-0345, USA
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16
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Discigil B, Boga M, Gürcün U, Soydas C, Yüksel M. Extracardiac Unruptured Sinus of Valsalva Aneurysm Presenting with Aortic Incompetence. Asian Cardiovasc Thorac Ann 1998. [DOI: 10.1177/021849239800600217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of extracardiac unruptured aneurysm of the noncoronary sinus of Valsalva presenting with massive aortic regurgitation and high fever. The preoperative evaluation, echocardiographic and cardiac catheterization findings, and surgical management of this rare condition are discussed.
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Affiliation(s)
| | - Mehmet Boga
- Department of Cardiovascular Surgery, Ege University Medical Faculty İzmir, Turkey
| | - Ugur Gürcün
- Department of Cardiovascular Surgery, Ege University Medical Faculty İzmir, Turkey
| | - Cahide Soydas
- Department of Cardiology, Ege University Medical Faculty İzmir, Turkey
| | - Münevver Yüksel
- Department of Cardiovascular Surgery, Ege University Medical Faculty İzmir, Turkey
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17
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San M, Demirtas M, Bozkurt A, Niazova Z, Birand A. Aorto-left atrial fistula associated with left coronary artery origin anomaly and bicuspid aortic valve and aortic regurgitation: a case report. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 39:330. [PMID: 8933987 DOI: 10.1002/(sici)1097-0304(199611)39:3<330::aid-ccd29>3.0.co;2-h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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18
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Silance PG, Van Camp G, Cosyns B, Brunet A, Vandenbossche JL. Echocardiographic diagnosis of right and left sinus of Valsalva aneurysms dissecting into the ventricular septum. J Am Soc Echocardiogr 1996; 9:190-4. [PMID: 8849616 DOI: 10.1016/s0894-7317(96)90028-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a case of dissection of the ventricular septum by two aneurysms of the right and left coronary sinuses of Valsalva. Transthoracic and transesophageal echocardiography allowed accurate preoperative assessment and postoperative evaluation.
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Affiliation(s)
- P G Silance
- Department of Cardiology, St-Pierre University Hospital, Brussels, Belgium
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19
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Tahir MZ, Rustom M, al Ebrahim K. Left coronary sinus of Valsalva aneurysm: an extremely rare malformation. A case report. Angiology 1995; 46:753-8. [PMID: 7639425 DOI: 10.1177/000331979504600817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The authors describe a sixty-four-year-old man who underwent coronary angiography for angina pectoris and was found to have a left coronary sinus aneurysm--an extremely rare malformation.
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Affiliation(s)
- M Z Tahir
- Al Hada Military Hospital, Taif, Kingdom of Saudi Arabia
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20
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Pannu HS, Shivaprakash K, Bazaz S, Bedi HS, Dhaliwal RS, Singh H, Suri RK, Gujral JS. Geographical variations in the presentation of ruptured aneurysms of sinuses of valsalva: evaluation of surgical repair. J Card Surg 1995; 10:316-24. [PMID: 7549189 DOI: 10.1111/j.1540-8191.1995.tb00618.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: 01/25/2023]
Abstract
From 1981 to 1992, 13 male and 7 female patients underwent surgical correction for ruptured aneurysms of sinus of valsalva. A total surgical experience of 22 procedures including 2 reoperations is presented, accounting for 1.37% of open heart surgery for congenital heart disease at PGIMER Chandigarh. Ninety percent were in the 20- to 40-year age group. Forty-five percent of patients had symptoms of > 1-year duration (range 2 months to 20 years) and catastrophic onset of symptoms was noted in four (18%). All patients had localized aneurysms originating either in right coronary sinus (14 pts) or noncoronary sinus (8 pts). Sites of origin and rupture are detailed. Associated congenital abnormalities such as ventricular septal defect (VSD) (13 pts), aortic regurgitation (3 pts), and left superior vena cava and atrial septal defect (ASD) (1 pt each) were noted. The data pertaining to Oriental and Western groups of patients were analyzed, and the differences in age, mode of presentation, site of origin, rupture, and the spectrum of associated abnormalities were elucidated. The majority of the patients (86.4%) were operated by the Bicameral approach. Repair was tailored according to the extent and severity of the defect in the sinus of Valsalva and aortic valve annulus and also the presence and site of VSD.
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Affiliation(s)
- H S Pannu
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Cottogni M, Antretter H, Wicke K. Subtotal rarefication of one aortic leaflet in a bicuspid aortic valve due to large aneurysm of left Valsalva's sinus. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1995; 29:87-90. [PMID: 8643933 DOI: 10.3109/14017439509107209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In a 39-year-old man an isolated, unruptured extracardiac aneurysm of the left sinus of Valsalva led to almost complete rarefication of one aortic valve leaflet, causing insufficiency of the valve. At operation the aneurysm entrance was closed with a patch and prosthetic replacement of the bicuspid aortic valve was performed. The result was satisfactory.
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Affiliation(s)
- M Cottogni
- Department of Surgery I, University of Innsbruck, School of Medicine, Austria
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22
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Holman WL. Sinus of Valsalva aneurysms and application of surgical science to their repair. Ann Thorac Surg 1993; 55:545-50; discussion 551. [PMID: 8431081 DOI: 10.1016/0003-4975(93)91046-p] [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: 01/30/2023]
Affiliation(s)
- W L Holman
- Division of Cardiothoracic Surgery, University of Alabama, Birmingham 35294
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23
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Jebara VA, Chauvaud S, Portoghese M, Uva MS, Acar C, Farge A, Dervanian P, Sarkis A, Bruneval P, Fabiani JN. Isolated extracardiac unruptured sinus of Valsalva aneurysms. Ann Thorac Surg 1992; 54:323-6. [PMID: 1637228 DOI: 10.1016/0003-4975(92)91393-n] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Reports concerning unruptured, isolated aneurysms of one sinus of Valsalva are rare. These aneurysms usually protrude inside the heart and are very rarely extracardiac. We report 4 cases of isolated, unruptured extracardiac aneurysms of the noncoronary sinus of Valsalva. Clinical symptoms were nonspecific. Operation was performed by patch reconstruction of the dilated aortic sinus without replacement of the ascending aorta. Microscopic examination of the diseased aortic wall revealed absence of medial elastic fibers. Late follow-up in all 4 cases revealed a normal ascending aorta with no dilatation of the aortic root and no aortic regurgitation.
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Affiliation(s)
- V A Jebara
- Department of Cardiovascular Surgery, Hôpital Broussais, Paris, France
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24
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Brugada P. Alcohol ablation of atrioventricular conduction. Heart 1991; 66:257-8. [PMID: 1931360 PMCID: PMC1024660 DOI: 10.1136/hrt.66.3.257-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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25
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Sullivan ID, De Leval MR. Echocardiographic diagnosis of a ruptured aneurysm of the sinus of Valsalva: operation without catheterisation in seven. Heart 1991; 66:258. [PMID: 1931361 PMCID: PMC1024661 DOI: 10.1136/hrt.66.3.258-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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26
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Abstract
We report a case of erosion of an aneurysm of the right sinus of Valsalva into the interventricular septum. The mode of presentation, the preoperative evaluation, and the echocardiographic and nuclear magnetic resonance imaging features are presented, and the cardiac catheterization findings and surgical management of this very rare cardiac pathology are discussed.
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Affiliation(s)
- H Raffa
- King Fahad Heart Center, Jeddah, Saudi Arabia
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27
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Abstract
Sinus of Valsalva aneurysms are rare cardiac anomalies which may be acquired or congenital. The congenital aneurysm is more common than the acquired form, with an incidence ranging from 0.1 to 3.5% of all congenital heart defects. Acquired aneurysms may result from trauma, endocarditis, syphilis, Marfan's syndrome, and senile-type dilatation in which the three sinuses dilate as a result of the normal aging process. This review focuses on both congenital and acquired aneurysms with particular attention to the noninvasive diagnosis of this anomaly.
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Affiliation(s)
- N Goldberg
- Department of Medicine, State University of New York Health Science Center, Brooklyn 11203
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28
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Chu SH, Hung CR, How SS, Chang H, Wang SS, Tsai CH, Liau CS, Tseng CD, Tseng YZ, Lee YT, Lien WP, Lue HC, Lin TY. Ruptured aneurysms of the sinus of Valsalva in Oriental patients. J Thorac Cardiovasc Surg 1990. [DOI: 10.1016/s0022-5223(19)37013-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Affiliation(s)
- J R Hemp
- Cardiac Surgery Service, Samuel Merritt Hospital, Oakland, California
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30
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31
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Abstract
A 62-year-old man with no history of preexisting heart disease was seen in cardiogenic shock. Prompt cardiac catheterization and aortography revealed pericardial tamponade and aneurysms of the right and left sinuses of Valsalva. Immediate sternotomy relieved the tamponade, which was secondary to an aneurysm of the left sinus of Valsalva rupturing into the transverse pericardial sinus. Endoaneurysmorrhaphy was performed successfully.
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32
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Abstract
A child in whom abnormal vessels connected the descending thoracic aorta and the left atrium is described. This is a previously unreported congenital malformation. Clinically this condition differs from the more common aorto-cardiac fistulas in that the continuous murmur was better heard posteriorly as well as in the right parasternal area. Ligation of the aberrant vessels abolished the murmur.
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33
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Mattila SP, Kupari M, Harjula AL, Ventilä M, Meurala H, Maamies TJ, Aho P. Ruptured aneurysm of sinus of Valsalva. Long-term postoperative follow-up. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1987; 21:233-8. [PMID: 3438719 DOI: 10.3109/14017438709106031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Ruptured sinus Valsalva aneurysm was repaired in 13 patients (mean age c. 33 years). Dyspnea, chest pain, fatigue and palpitation were the most common symptoms and systodiastolic murmur, cardiomegaly and pulmonary congestion the most pertinent clinical findings. The pulmonary-to-systemic flow ratio averaged c. 2.5. Associated cardiac anomalies were ventricular septal defect, aortic or mitral regurgitation, aortic coarctation or subvalvular stenosis, tetralogy of Fallot (altogether 8 cases). The origin of the fistula was the noncoronary, right coronary or left coronary sinus (5, 4 and 3 cases) or was not identifiable (1 case). Rupture occurred into the right atrium (6 cases), right ventricle (6) or pulmonary artery (1 case). Repair was undertaken through aortotomy (6 cases), right ventriculotomy (2) or right atriotomy (1) or through aortotomy + right ventriculotomy or atriotomy (4). In one case aortic valve replacement was performed. All survived the operation. Follow-up averaged 9.6 years. Recurrent fistulation, though with small shunt, was found in two cases. Combined two-dimensional and Doppler echocardiography revealed minor cardiac abnormalities in most patients, particularly aortic regurgitation. All the patients were in NYHA function class I or II.
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Affiliation(s)
- S P Mattila
- Department of Thoracic and Cardiovascular Surgery, University Central Hospital, Helsinki, Finland
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34
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35
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36
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Raizes GS, Smith HC, Vlietstra RE, Puga FJ. Ventricular tachycardia secondary to aneurysm of sinus of Valsalva. J Thorac Cardiovasc Surg 1979. [DOI: 10.1016/s0022-5223(19)38170-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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37
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38
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Norwicki ER, Aberdeen E, Friedman S, Rashkind WJ. Congenital left aortic sinus-left ventricle fistula and review of aortocardiac fistulas. Ann Thorac Surg 1977; 23:378-88. [PMID: 849055 DOI: 10.1016/s0003-4975(10)64149-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A fistula from the left aortic sinus to the left ventricle is reported that was successfully repaired using cardiopulmonary bypass. In addition, 175 cases of fistula to the heart from the aortic sinuses published in the English literature from 1839 through 1972 were studied, with particular emphasis on the 126 patients who underwent operative repair. The major cause of the fistulas (76%) was found to be rupture of a congenital aortic sinus aneurysm, usually during the third or fourth decade of life. The remainder of these fistulas to the heart consisted of simply a tract in an otherwise normal sinus. Ventricular septal defect was the most common associated defect and, when present, was nearly always related to a fistula arising from the right aortic sinus. Repair was successful in 86% of the 126 operated patients. The principles of operative treatment of these fistulas are reviewed.
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39
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40
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Heydorn WH, Nelson WP, Fitterer JD, Floyd GD, Strevey TE. Congenital aneurysm of the sinus of Valsalva protruding into the left ventricle. J Thorac Cardiovasc Surg 1976. [DOI: 10.1016/s0022-5223(19)40117-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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42
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Temes GD, Wheat MW. The management of aneurysms of the aorta. Dis Mon 1974:1-38. [PMID: 4496806 DOI: 10.1016/s0011-5029(74)80003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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43
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WILSON AC, Simpson WL, Richardson JP, Clarebrough JK. Mycotic aneurysms of the aortic root. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1972; 42:113-22. [PMID: 4533401 DOI: 10.1111/j.1445-2197.1972.tb06757.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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44
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Fjeld NB, Froysaker T, Efskind L. Surgical correction of sinus of Valsalva fistulas. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1972; 6:131-5. [PMID: 5046336 DOI: 10.3109/14017437209134790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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45
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Bonfils-Roberts EA, DuShane JW, McGoon DC, Danielson GK. Aortic sinus fistula--surgical considerations and results of operation. Ann Thorac Surg 1971; 12:492-502. [PMID: 5127762 DOI: 10.1016/s0003-4975(10)65796-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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46
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47
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Trinkle JK, Mobin-Uddin K, Bryant LR. Primary anastomosis of aneurysms of the ascending aorta caused by cystic medial necrosis. J Thorac Cardiovasc Surg 1971. [DOI: 10.1016/s0022-5223(19)42085-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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