1
|
Ayati A, Toofaninejad N, Hosseinsabet A, Mohammadi F, Hosseini K. Transcatheter closure of a ruptured sinus of valsalva: a systematic review of the literature. Front Cardiovasc Med 2023; 10:1227761. [PMID: 37727309 PMCID: PMC10505828 DOI: 10.3389/fcvm.2023.1227761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023] Open
Abstract
Background Ruptured sinus of Valsalva (RSOV) is a rare pathology, and current data regarding its symptoms, anatomy, associated pathologies, and appropriate therapeutic approaches are scarce. Transcatheter closure (TCC) has been performed in multiple cases; however, the information on its success rate and complications is limited. Methods Two independent reviewers performed an advanced search based on inclusion criteria on Scopus, PubMed, and Embase from January 1985 through July 2022. The main search terms were "Sinus of Valsalva", "Rupture/Aneurysm", and "Transcatheter/Catheter/Device". Results Totally, 1,017 relevant articles from the 3 databases were retrieved. After the final review and appraisal, 94 articles describing 407 patients who underwent the TCC of RSOV were included. Males comprised 65% of the studied patients, and the average age was 34.5 years. The total success rate of TCC was 95.6%. Forty-nine patients (12%) developed complications, the most significant of which were sustained residual shunts in 7 patients (1.7%), substantial new onset or progression of aortic insufficiency in 6 (1.5%), and RSOV recurrence in 6 (1.5%). Post-interventional mortality was reported in only 2 patients (0.5%). Conclusions The present study is the first systematic review of available data regarding the TCC of RSOV principally comprising case series and case reports. Although TCC seems a good option, precise patient selection is mandatory.
Collapse
|
2
|
Abohelwa M, Elmassry M, Whisenant T, Thongtan T, Sethi P. Sinus of Valsalva aneurysm presenting with chest pain. Proc AMIA Symp 2020; 34:283-285. [PMID: 33678964 PMCID: PMC7901386 DOI: 10.1080/08998280.2020.1855620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022] Open
Abstract
Sinus of Valsalva aneurysm is a rare aortic root defect that can be dangerous due to its serious complications. It is defined as dilatation of one or more of the aortic valve sinuses. It is usually asymptomatic, and patients rarely present with chest pain, arrhythmias, or heart failure. We report a 29-year-old man who presented with atypical chest pain of 8 months with a normal cardiovascular exam. His laboratory work was unremarkable. Transthoracic echocardiography and transesophageal echocardiography showed a calcified sinus of Valsalva aneurysm arising from the noncoronary cusp. The patient underwent aneurysm repair surgery with no complications, and his chest pain resolved.
Collapse
Affiliation(s)
- Mostafa Abohelwa
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Mohamed Elmassry
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ty Whisenant
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Thanita Thongtan
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Pooja Sethi
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| |
Collapse
|
3
|
Xu B, Kocyigit D, Betancor J, Tan C, Rodriguez ER, Schoenhagen P, Flamm SD, Rodriguez LL, Svensson LG, Griffin BP. Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review. J Am Soc Echocardiogr 2020; 33:295-312. [PMID: 32143779 DOI: 10.1016/j.echo.2019.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/18/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Cardiovascular imaging has an important role in the assessment and management of aortic root and thoracic aorta ectasia and aneurysms. Sinus of Valsalva aneurysms are rare entities. Unique complications associated with sinus of Valsalva aneurysms make them different from traditional aortic root aneurysms. Established guidelines on the diagnosis and management of sinus of Valsalva aneurysms are lacking. This article reviews the applications of multimodality cardiovascular imaging (echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging) for the dedicated assessment and imaging-guided management of sinus of Valsalva aneurysms.
Collapse
Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Carmela Tan
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - E Rene Rodriguez
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
4
|
Galeczka M, Glowacki J, Yashchuk N, Ditkivskyy I, Rojczyk D, Knop M, Smerdzinski S, Cherpak B, Szkutnik M, Bialkowski J, Fiszer R, Lazoryshynets V. Medium- and long-term follow-up of transcatheter closure of ruptured sinus of Valsalva aneurysm in Central Europe population. J Cardiol 2019; 74:381-387. [PMID: 31023567 DOI: 10.1016/j.jjcc.2019.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/07/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to evaluate medium- and long-term outcomes of transcatheter closure (TC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease. METHODS Retrospective analysis included 23 patients (14 males) aged 15-79 years (y; 39.9±18.5) selected for TC of RSVA between 2007 and 2017 in two tertiary centers in Poland and Ukraine. Fifteen patients were in New York Heart Association (NYHA) class III or IV before TC; 5 patients had acquired RSVA after previous cardiac surgery. We applied 22 duct, 3 muscular, and 1 atrial septal Amplatzer or Amplatzer-like occluders by the anterograde venous approach after arterio-venous loop creation in all but 1 patient. Mean follow-up conducted in outpatient clinic was 5.5±3.5 (1-11)y. RESULTS The procedure was successful in 19/23 patients (82.6%). Four procedures were abandoned and the device percutaneously retrieved due to coronary artery compression (1 patient), transient increase of aortic regurgitation (AR; 1 patients) or embolization (2 patients). New onset of significant AR was noted in one of the latter patients after device removal. NYHA class improved in all treated patients but 2, in whom it remained stable (p<0.05), with 10 patients in class I. Three patients needed percutaneous re-intervention during follow-up because of significant residual shunt in 1 and late recurrent RSVA in 2 patients. The follow-up of the remaining patients was uneventful. Neither erosion, embolization, new AR, nor death were observed. CONCLUSIONS The percutaneous closure of RSVA is a safe and effective method of treatment with good clinical outcome. However, although not described previously, recurrent shunts after TC of RSVA are possible and can be treated successfully with another transcatheter intervention.
Collapse
Affiliation(s)
- Michal Galeczka
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - Jan Glowacki
- Department of Radiology and Radiodiagnostics, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Nataliia Yashchuk
- Department of Interventional Cardiology for Congenital and Acquired Heart Disease, National Amosov Institute, Kyiv, Ukraine
| | - Igor Ditkivskyy
- Department of Cardiovascular Surgery, National Amosov Institute, Kyiv, Ukraine
| | - Dominika Rojczyk
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Mateusz Knop
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Sebastian Smerdzinski
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Bogdan Cherpak
- Department of Interventional Cardiology for Congenital and Acquired Heart Disease, National Amosov Institute, Kyiv, Ukraine
| | - Malgorzata Szkutnik
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Jacek Bialkowski
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Roland Fiszer
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Vasyl Lazoryshynets
- Department of Cardiovascular Surgery, National Amosov Institute, Kyiv, Ukraine
| |
Collapse
|
5
|
An unusual cause of acute chest pain: rupture of the noncoronary sinus of Valsalva into the right atrium. Am J Emerg Med 2016; 34:2052.e1-2052.e3. [PMID: 27033738 DOI: 10.1016/j.ajem.2016.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022] Open
|
6
|
Weinreich M, Yu PJ, Trost B. Sinus of valsalva aneurysms: review of the literature and an update on management. Clin Cardiol 2015; 38:185-9. [PMID: 25757442 DOI: 10.1002/clc.22359] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/08/2014] [Accepted: 10/18/2014] [Indexed: 01/22/2023] Open
Abstract
Sinus of Valsalva aneurysm (SOVA), a congenital or acquired cardiac defect that is present in roughly 0.09% of the general population, often presents as an incidental finding during cardiac imaging. Although an echocardiogram is the standard imaging technique for such findings, cardiac computed tomography angiography (CCTA) has been increasingly utilized. If SOVA is diagnosed, CCTA is also a useful test for patients who are at low to intermediate risk for coronary artery disease (CAD) prior to surgical repair. CCTA can accurately rule out CAD, obviating the need for invasive angiography in most cases, which may be more risky in SOVA patients because their coronaries may be more difficult to engage and their aortic root may be more prone to injury. Although surgery has previously been the treatment of choice, transcatheter techniques have added to the spectrum of nonsurgical alternatives for repair. We report here 4 incidental SOVA cases and review the current literature.
Collapse
Affiliation(s)
- Michael Weinreich
- Department of Medicine, North Shore-Long Island Jewish Health System/Hofstra University School of Medicine, Manhasset, New York
| | | | | |
Collapse
|
7
|
Kuriakose EM, Bhatla P, McElhinney DB. Comparison of reported outcomes with percutaneous versus surgical closure of ruptured sinus of Valsalva aneurysm. Am J Cardiol 2015; 115:392-8. [PMID: 25488356 DOI: 10.1016/j.amjcard.2014.11.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/04/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Abstract
Sinus of Valsalva aneurysm is a rare cardiac malformation that stems from incomplete fusion of the aortic media and the aortic valve annulus, a weakness that may result in rupture of the sinus, large left-to-right shunt, and severe congestive heart failure. Historically, this lesion has been repaired surgically, but percutaneous closure (PC) has emerged as a therapeutic intervention over the last 20 years. We review and contrast 34 studies detailing the PC approach with 16 studies on surgical closure (SC), together comprising a total of 877 patients who were treated for ruptured sinus of Valsalva aneurysm from 1956 to 2014. Both groups had similar sites of rupture, age distribution, and clinical symptoms at presentation. Selection bias ultimately prohibits a direct comparison between the 2 groups as patients who underwent SC often had worse aortic regurgitation and more complex associated lesions, including endocarditis, bicuspid aortic valve, tunnel-type fistulous connections, larger defect size, and multiple site of rupture. In conclusion, although SC is indicated and reserved for these more complicated patients, our review of previously published reports reveals that PC in patients who are too ill to undergo bypass, with mild or no aortic regurgitation and simple associated defects (muscular ventricular septal defects, secundum atrial septal defect, small patent ductus arteriosus), can be safe, effective, and practical.
Collapse
|
8
|
Rittger H, Gundlach U, Koch A. Transcatheter closure of ruptured sinus of Valsalva aneurysm into the right ventricle with an Amplatzer Vascular Plug II. Catheter Cardiovasc Interv 2014; 85:166-9. [DOI: 10.1002/ccd.25382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/22/2013] [Accepted: 12/26/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Harald Rittger
- Medizinische Klinik 2; Universitätsklinikum Erlangen; Erlangen Germany
| | - Ulrike Gundlach
- Medizinische Klinik 2; Universitätsklinikum Erlangen; Erlangen Germany
| | - Andreas Koch
- Klinik für Kinderkardiologie; Universitätsklinikum Erlangen; Erlangen Germany
| |
Collapse
|
9
|
Gioia G, Zheng J, Ray A, Gioia M. Perforated Sinus of Valsalva (PSOV) aneurysm closure with a muscular VSD occluder. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 15:165-70. [PMID: 24216001 DOI: 10.1016/j.carrev.2013.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/26/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
We report a case of a Perforated Sinus of Valsalva Aneurysm (PSOV) closure using an Amplatzer muscular ventricular septal defect occluder (mVSD) device and describe a novel and potentially safer way for defect sizing. A literature review of the endovascular treatment of this disease is presented.
Collapse
Affiliation(s)
- Giuseppe Gioia
- AtlantiCare Regional Medical Center, Pomona NJ, USA; Cardiac Cath Lab, AtlantiCare Regional Medical Center, Pomona NJ 08205, USA.
| | - Jingsheng Zheng
- AtlantiCare Regional Medical Center, Pomona NJ, USA; Cardiac Cath Lab, AtlantiCare Regional Medical Center, Pomona NJ 08205, USA
| | - Amit Ray
- AtlantiCare Regional Medical Center, Pomona NJ, USA; Cardiac Cath Lab, AtlantiCare Regional Medical Center, Pomona NJ 08205, USA
| | - Mario Gioia
- AtlantiCare Regional Medical Center, Pomona NJ, USA; Cardiac Cath Lab, AtlantiCare Regional Medical Center, Pomona NJ 08205, USA
| |
Collapse
|
10
|
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
|
11
|
Khoury A, Khatib I, Halabi M, Lorber A. Transcatheter closure of ruptured right-coronary aortic sinus fistula to right ventricle. Ann Pediatr Cardiol 2011; 3:178-80. [PMID: 21234201 PMCID: PMC3017926 DOI: 10.4103/0974-2069.74052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 22-year-old man was referred for evaluation of exertional fatigue. On examination, there were no overt signs of congestive heart failure. Transthoracic and transesophageal echocardiography revealed rupture of the right coronary aortic sinus of Valsalva into the right ventricle. It was successfully closed with a 12 × 10 Amplatzer duct occluder.
Collapse
Affiliation(s)
- Asaad Khoury
- Department of Pediatric Cardiology, Rambam Health Care Campus, Technion-Institute of Technology, Haifa, Israel
| | | | | | | |
Collapse
|
12
|
Lindsey J, Cohen D, Stolker J, Meht S, Mahoney E, Robertus K, House J, Kennedy K, Riggs L, Rao S, Marso S. The impact of bivalirudin on percutaneous coronary intervention-related bleeding. EUROINTERVENTION 2010. [DOI: 10.4244/eijv6i2a33] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
13
|
Sivadasanpillai H, Valaparambil A, Sivasubramonian S, Mahadevan K, Sasidharan B, Namboodiri N, Thomas T, Jaganmohan T. Percutaneous closure of ruptured sinus of Valsalva aneurysms: intermediate term follow-up results. EUROINTERVENTION 2010. [DOI: 10.4244/eijv6i2a34] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
14
|
Fischer G, Smevik B, Novoa JCR, Suáres FJO, Kramer HH, Bjørnstad PG. Catheter-based treatment with the Amplatzer® devices in alien positions. Catheter Cardiovasc Interv 2009; 73:669-75. [DOI: 10.1002/ccd.21899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Zhao SH, Yan CW, Zhu XY, Li JJ, Xu NX, Jiang SL, Xu ZY, Wang C, Wu WH, Hai-Bo H, Li SG, Ye ZK, Wang H. Transcatheter occlusion of the ruptured sinus of Valsalva aneurysm with an Amplatzer duct occluder. Int J Cardiol 2008; 129:81-5. [PMID: 17659794 DOI: 10.1016/j.ijcard.2007.06.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 05/21/2007] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ruptured sinus of Valsalva aneurysm (RSVA) can be associated with ventricular septal defects or isolated lesions. Percutaneous transcatheter closure of RSVA has been an alternative strategy to surgery. The results of transcatheter closure of the RSVA in 10 patients were presented. METHODS From January 2000 to May 2006, 10 patients (4 males, 6 females) aged from 7 years to 69 years (mean ages 37+/-18.8 years) were involved in the present report. The diagnosis of RSVA was made based on a combination of several imaging modalities. Of them, 9 patients were identified as congenital cause and one did as acquired RSVA. Two-dimensional and color Doppler echocardiography revealed the rupture of right coronary sinus into right ventricle in 5 cases and into right atrium in 3 cases, while non-coronary sinus ruptured into right atrium in 2 cases. Aortogram showed that the estimated size of the defect was 6.2+/-2.3 mm (2-10 mm). After the establishment of the arterio-venous wire loop, Amplatzer duct occluder (ADO) was deployed by antegrade venous approach in all patients. RESULTS ADO with 1-3mm larger than the defect was used. All defects were successfully occluded without any complications. On the follow-up, echocardiography showed neither residual shunt nor aortic regurgitation, and there was also no device embolization, infective endocarditis in any of the patients. CONCLUSIONS Transcatheter closure is a feasible and effective alternative for both congenital and acquired RSVA. However, long-term follow-up is mandatory.
Collapse
Affiliation(s)
- Shi-Hua Zhao
- Department of Radiology and Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Peña JJ, Marqués JI, Mateo E, Llagunes J, Aguar F, de Andrés J. [Perioperative management of a ruptured sinus of Valsalva aneurysm]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:175-178. [PMID: 18401992 DOI: 10.1016/s0034-9356(08)70536-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Congenital sinus of Valsalva aneurysms are extremely rare in Spain. The lesion consists of a defect that allows the aortic media to separate from the annulus fibrosus of the aortic valve, causing it to dilate with arterial pressure. The natural course of the aneurysm involves the risk of complication due to bacterial endocarditis, with conduction blocks or myocardial ischemia. Rupture of the aneurysm, usually into a right chamber, causes a left-right shunt that leads to heart failure and death if untreated. We present the case of a previously asymptomatic 60-year-old woman who presented with a clinical picture that led to a diagnosis of hyperthyroidism, and in whom there occurred a coincident rupture of a congenital sinus of Valsalva aneurysm. We describe the anesthetic procedure and emphasize the importance of intraoperative echocardiography throughout the resection of the aneurysm.
Collapse
Affiliation(s)
- J J Peña
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia.
| | | | | | | | | | | |
Collapse
|
17
|
Khalil A, Helmy T, Tarik T, Porembka DT. Aortic pathology: aortic trauma, debris, dissection, and aneurysm. Crit Care Med 2007; 35:S392-400. [PMID: 17667464 DOI: 10.1097/01.ccm.0000270276.01938.c0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aorta is a conduit from the left ventricle that delivers pulsatile blood distally in either a compliant or stiffened vessel to organs and tissue beds. Only recently, since the advent of transesophageal echocardiographic imaging, did its presence and associated pathologies become more profound and more prominent for the intensivist. Angiography, the "gold standard" for diagnostic imaging, now seems to be in question since the advent of ultrasound (transesophageal echocardiography), improvements in magnetic resonance imaging, and particularly the advancement to 64-slice computed tomography. It is now a revelation of how revealing these newer imaging tools have expanded our knowledge potential of pathologies that involve the aorta. The latter three imaging modalities are continuing to improve, with established efficacy, particularly in the critically ill and injured patient. This article will enlighten the intensivist and others of their potential and contrast each imaging device in several prominent pathologies common to the critical care physician. The disadvantages of all will be brought forth. Evidence will be presented revealing the dynamic nature of imaging technologies that will continue to affect the outcome of our patients. The most common indications for interrogation of the aorta are in traumatic events in which there might be a catastrophic transection, intimal tear or flap, or subadventitial tear. The identification of hematomas (by these imaging devices) in the mediastinum might be associated with significant physical forces, and this article will show the relevance. The significance of atherosclerotic plaques, ulcers, and debris will also be debated. Finally, imaging of a patient with aortic dissection or aneurysm will be discussed, as its pathology and pathogenic process are well known, and the changing nature or paradigm shift in the imaging of this life-threatening disease will be addressed.
Collapse
Affiliation(s)
- Ahmed Khalil
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | | | | | | |
Collapse
|
18
|
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.
Collapse
Affiliation(s)
- Giuseppe Santoro
- Division of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
| | | | | | | | | | | |
Collapse
|
19
|
Gaio G, Santoro G, Iacono C, Carrozza M, Cappelli Bigazzi M, Giovanna Russo M, Calabrò R. Non-surgical treatment of ruptured sinus of Valsalva aneurysm. Int J Cardiol 2006; 113:e44-5. [PMID: 17045668 DOI: 10.1016/j.ijcard.2006.07.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 07/08/2006] [Indexed: 11/28/2022]
|
20
|
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.
Collapse
Affiliation(s)
- Dmitriy N Feldman
- Division of Cardiology, New York Presbyterian Hospital-Weill Medical College of Cornell University, NY 10021, USA.
| | | |
Collapse
|