Aneurysms of the Sinuses of Valsalva

Sudden Death Due to Rupture of Aneurysm of Sinus Valsalva: An Autopsy Case

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.

Right coronary ischaemia caused by a sinus of Valsalva aneurysm improved by releasing mechanical stretch: a case report

Background

A sinus of Valsalva aneurysm involving a single cusp is a rare condition, and coronary computed tomography angiography with fractional flow reserve-computed tomography helps evaluate not only the anatomical aspects of the aneurysm and coronary artery but also the physiological details of coronary artery disease.

Case summary

A 71-year-old woman presented with exertional chest pain and dyspnoea. Enhanced computed tomography revealed an aneurysmal change in the right sinus of Valsalva, and coronary computed tomography angiography revealed diffuse narrowing of the proximal segment of right coronary artery due to mechanical stretching by the large Valsalva aneurysm. Fractional flow reserve-computed tomography revealed a significantly low fractional flow reserve (0.50 in the distal right coronary artery). A modified Bentall procedure was performed with a 21 mm bioprosthetic valve and a 24 mm Valsalva graft conduit for the aortic root aneurysm; mitral valve annuloplasty was performed for mitral valve regurgitation. Post-operative coronary computed tomography angiography revealed no significant stenosis in the proximal segment of the right coronary artery. Furthermore, fractional flow reserve-computed tomography revealed a normalized fractional flow reserve in the distal right coronary artery. The patient experienced relief from chest pain and was discharged 19 days after the surgery.

Discussion

A right coronary sinus of Valsalva aneurysm, which caused right coronary artery ischaemia, was successfully treated using a modified Bentall procedure. Coronary computed tomography angiography and fractional flow reserve-computed tomography revealed anatomical and functional improvements in the right coronary artery ischaemia post-operatively.

Ruptured Sinus of Valsalva Aneurysm: Three Case Reports and Literature Review

Sinus of Valsalva aneurysm rupture (SOVAR) into the right cardiac chambers is an uncommon complication with unusual presentation, high morbidity and mortality, and unique hemodynamics as well as cardiac imaging findings. Here, we present three SOVAR cases (two with rupture into the right atrium and one with rupture into the right ventricle) that were initially confused for ventricular septal defects and describe their initial presentation, cardiac imaging studies, invasive hemodynamics, as well as treatment options. Some of the unique findings of SOVAR patients include an acute presentation, often with hemodynamic decompensation, the presence of a continuous murmur on examination, and also hemodynamics that include wide pulse pressure and right heart volume overload.

Application of extracorporeal membrane oxygenation in the remote transport of a patient with a ruptured sinus of Valsalva aneurysm: a case report

Background

A ruptured sinus of Valsalva aneurysm can lead to rapid heart failure and sudden cardiac death. Management of patients who develop severe heart failure and need to be transferred to a specialized hospital for surgical treatment can be challenging. In patients with severe shock due to a ruptured sinus of Valsalva aneurysm into the right atrium, extracorporeal membrane oxygenation (ECMO) transport is an effective means to ensure patient safety, but increases the right cardiac load. We report the experience of veno-arterial (VA) ECMO transport in the treatment of acute cardiogenic shock caused by rupture of a congenital sinus of Valsalva aneurysm.

Case presentation

We describe the case of an 18-year-old male who began having acute episodes of chest pain, shortness of breath, palpitations, and dizziness 18 h before presenting to the emergency department. An echocardiogram revealed an acute ruptured sinus of Valsalva aneurysm and a shunt to the right atrium. The patient presented with severe shock. VA-ECMO was administered to ensure safe transport to the cardiac center. The outcome of emergency surgical repair was good. The patient was on ECMO for 8 h. He returned to the general ward after 7 days and was successfully discharged after 40 days. He had good exercise tolerance 2 years after surgery and no evidence of heart failure.

Conclusion

Although ECMO transport can increase right cardiac load, it is an effective and safe method to move patients with severe shock caused by a ruptured sinus of Valsalva aneurysm into the right atrium. Methods to decrease right cardiac load, such as decreasing ECMO flow combined with cardiotonic drugs, should be adopted. Successful treatment involves rapid establishment of cardiopulmonary bypass and urgent repair of the ruptured sinus of Valsalva aneurysm.

Ruptured Sinus of Valsalva Aneurysm in a Patient with a Ventricular Septal Defect Who Dropped Out of Lifelong Medical Follow-up

Ruptured sinus of Valsalva aneurysm (RSOVA) is a rare cardiac condition associated with high morbidity and mortality rates. We herein report a 35-year-old man with a history of ventricular septal defect (VSD). He had a history of interrupted hospital visits and presented to the emergency department with dyspnea, palpitations, and dizziness for a few days. Auscultation detected a continuous murmur. Transthoracic echocardiography followed by transesophageal echocardiography demonstrated RSOVA in the right ventricle with an aorto-right ventricular fistula. The fistula was resected, and the aneurysm was surgically repaired. The patient made a good recovery.

Percutaneous Closure of a Ruptured Sinus of Valsalva Aneurysm under Transesophageal Echocardiography Guidance

•SOVA is a rare cardiac anomaly. •Ruptured SOVA carries a high mortality rate. •SOVA often coexists with other congenital lesions, most commonly VSD and bicuspid AV. •Ruptured SOVA needs repair; percutaneous repair is a safe alternative to surgery. •Echo plays a vital role in both diagnosing SOVA and guiding percutaneous closure.

Left coronary sinus of valsalva aneurysm dissecting into interventricular septum: a case report

BACKGROUND

Sinus of Valsalva aneurysm (SVA) is an extremely rare condition, and its rupture causes acute symptoms such as chest pain and dyspnea. Ruptured SVA is frequently associated with other congenital defects.

CASE PRESENTATION

A 37-year-old male presented with SVA originating from the left coronary sinus that ruptured into the interventricular septum. SVA was diagnosed by echocardiography, cardiac computed tomography and magnetic resonance imaging, and confirmed during the operation.

CONCLUSIONS

SVA is a rare cardiac abnormality which can lead to severe clinical symptoms upon rupture. Immediate surgery is necessary to repair the ruptured SVA.

Ruptured Sinus of Valsalva Aneurysm with Resultant Myocardial Pouch Formation in the Fetal Heart-A Diagnostic Challenge

Sinus of Valsalva aneurysms (SVAs) are infrequently seen in the pediatric population. When these aneurysms rupture, a significant hemodynamic burden is placed on the heart and increases the likelihood of cardiac failure. Here, we report a case of a ruptured SVA into the ventricular myocardium in a fetus with a form of double-inlet left ventricle. To the best of our knowledge, this has not previously been described.

Left sinus of Valsalva aneurysm causing acute myocardial infarction with compression of the left main coronary trunk

Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that commonly originates from the right or noncoronary sinuses and rarely from the left sinus. SVA is usually diagnosed in the setting of clinical sequelae of a rupture. We herein report a case of an unruptured left SVA presenting as acute myocardial infarction. A 54-year-old woman with a history of radical operation for patent ductus arteriosus in childhood was transferred to our hospital. An electrocardiogram indicated extensive myocardial ischemia with ST elevation. Urgent coronary angiography was performed but was unable to identify the left coronary artery. Subsequent aortography and computed tomography revealed a large SVA originating from the left sinus and compressing the left coronary artery. The patient died after approximately one month of intensive care, including mechanical circulatory support and coronary artery bypass grafting. Autopsy confirmed that the left main coronary trunk was stretched and compressed by the SVA and revealed unexpected atherosclerosis in the left anterior descending artery. Although a left SVA is an extremely rare anomaly, it occasionally provokes fatal myocardial infarction. Since an SVA might hinder performing percutaneous coronary intervention, cardiac surgery should be considered when myocardial ischemia is recognized.

Learning objective

We herein report a case of an unruptured left sinus of Valsalva aneurysm (SVA) with acute myocardial infarction. Urgent percutaneous coronary intervention (PCI) was unsuccessful, as the left coronary artery was compressed by the SVA. The patient died after intensive care, including coronary artery bypass grafting (CABG). SVA, especially from the left sinus, is extremely rare but occasionally provokes myocardial infarction by compressing the coronary arteries. Because SVA might hinder PCI, CABG should be considered when myocardial ischemia is recognized.

Severe Aortic Regurgitation From Sinus of Valsalva Aneurysm Prolapse

•Unruptured SVAs are usually asymptomatic but can present with significant HF. •A large SVA can compress or displace nearby structures and cause valvular abnormalities. •Echocardiography plays an important role in diagnosis and management of SVA.

Case Report: Myocardial dissection caused by ruptured sinus of Valsalva aneurysm in association with a bicuspid aortic valve

In this report, we present a case of left-right sinus fusion in a Ruptured sinus of Valsalva aneurysm (RSVA) that perforated into the myocardium, giving rise to myocardial dissection. The existence of an anomalous bicuspid aortic valve (BAV) is contemplated as a potential etiological element in this context. Employing multimodal imaging modalities, encompassing transthoracic echocardiography and computed tomography (CT), facilitated the visualization of a dissecting hematoma situated within the myocardium subsequent to the RSVA. Following this, our patient underwent an Cabrol surgical intervention, received patch repair, and underwent mitral valve annuloplasty, during which a three-year period transpired without the occurrence of any deleterious cardiac events. In summary, this report establishes the cornerstone for the surgical intervention of RSVA, shedding light on the efficacious handling of RSVA-associated myocardial dissection. It posits that the presence of a BAV may serve as a predisposing factor to RSVA rupture, potentially elevating the susceptibility to myocardial dissection. The utilization of diverse multimodal imaging methodologies played an indispensable role in the detection of a hematoma within the myocardial tissue subsequent to the RSVA rupture. The uneventful three-year postoperative follow-up of the patient underscores the efficacy of the undertaken interventions.

Unusual Case of Acute Coronary Syndrome Due to Compression of the Left Main Coronary Artery From a Contained Aortic Root Perforation

We present an intriguing and rare case of a 71-year-old male who presented with a non-ST elevation myocardial infarction (NSTEMI). Initial coronary angiography revealed severe and unusual systolic extrinsic compression of the left main coronary artery (LM), warranting further advanced imaging investigations. Computed tomography angiography (CTA) and transesophageal echocardiography (TEE) were employed to determine the underlying cause, which was identified as a contained aortic rupture leading to the formation of a pseudoaneurysm in the left coronary sinus of Valsalva and aortic root. This condition was found to be a sequela of previously undiagnosed endocarditis, likely secondary to lower extremity osteomyelitis and bacteremia, for which the patient received prolonged intravenous (IV) antibiotic therapy. This case highlights the critical role advanced imaging techniques play in accurately diagnosing and characterizing complex cardiovascular abnormalities, enabling early intervention and optimizing patient outcomes. Healthcare providers should remain vigilant for such atypical presentations to ensure timely and appropriate management.

A Case of Sinus of Valsalva Aneurysm Rupture Causing Cardiogenic Shock

A sinus of Valsalva aneurysm (SVA) is an abnormal dilation between the aortic valve annulus and sinotubular junction resulting from weakness in the elastic lamina. In the vast majority of cases, SVAs are asymptomatic and are incidentally detected on echocardiogram imaging. In some cases, they can rupture and lead to an intracardiac shunt. Sudden rupture of a high-flow aneurysm can lead to significant hemodynamic compromise and a high fatality rate if not diagnosed early and intervened upon. We present the case of a 68-year-old male who presented with symptoms of heart failure and later rapidly deteriorated due to a sudden spontaneous rupture of the SVA leading to cardiogenic shock. In our case, timely identification and intervention led to a good outcome for our patient. We also present echocardiogram images and videos to educate the readers further about diagnosing SVA. With this case report, we would like to help clinicians and researchers expand their understanding of the condition and treatment outcomes.

Sinus of Valsalva Aneurysm: An Atypical Etiology of Recurrent Syncope

The sinus of Valsalva presents the initial segment of the aorta from where the coronary vessels arise. Sinus of Valsalva aneurysms (SOVAs) present as progressive dilatation of the aortic sinus. SOVA arises both from the congenital and acquired weakness of the elastic lamina of the aortic media. Though most of the SOVAs are asymptomatic and diagnosed on screening for other pathologies, patients can present with symptoms of arrhythmia, aortic insufficiency, aorto-cardiac fistulas, and, in a few cases, with rupture. We describe a patient who presented with recurrent syncope and was found to have a 6 cm dilated SOVA with an ectatic ascending aorta. Further assessment revealed a left anterior fascicular block, aortic regurgitation, and mitral regurgitation. On further assessment, no other cause of syncope was found. There was no family history of aneurysm or sudden cardiac death. The patient was eventually discharged with outpatient follow-up with cardiothoracic surgery. In patients presenting with asymptomatic SOVA, a dilatation with a maximum diameter of 6.0 cm requires stringent monitoring and should be considered for surgery.

Intravenous thrombolysis in a patient with acute ischemic stroke associated with a ruptured sinus Valsalva aneurysm: The first case report

Sinus Valsalva aneurysms (SVA) are rare asymptomatic cardiac anomalies, which can rupture and cause heart failure, myocardial infarction and also, they can be a potential source for embolic strokes. We report the first case of a patient with acute ischemic stroke associated with a ruptured SVA, who was treated with intravenous thrombolysis (tPA) without further complications.

A rare variant of a ruptured sinus of valsalva aneurysm forming an aorto-atrial fistula: a case report and review of literature

Background

Sinus of valsalva aneurysms (SOVAs) are infrequent findings and generally diagnosed incidentally. A SOVA may be at risk for rupture, which would lead to an aorto-cardiac shunt. These patients present similarly to decompensated heart failure.

Case Presentation

We present a case of a 44-year-old female with a ruptured non-coronary SOVA diagnosed by echocardiogram during evaluation for exertional dyspnoea. A trans-oesophageal echocardiogram (TEE) revealed a 2.1 cm non-coronary SOVA with windsock communication to the right atrium. The patient refused surgery, and two years later, presented with florid right heart failure with preserved left ventricular function. The right ventricle was severely dilated and hypokinetic with right atrial enlargement. After finally agreeing to surgery, a pre-operative catheterization revealed non-obstructive coronaries and a significant left to right shunt with elevated pulmonary pressure. The patient had suboptimal response to diuretic therapy and was sent for successful repair of the aneurysm with the closure of the aorto-atrial fistula via bovine pericardial patch and resolution of the left to right shunt as demonstrated by intra-operative TEE. Her right-sided heart failure symptoms subsequently resolved.

Discussion

SOVA is a rare finding but should still be considered in the differential in young and middle-aged patients with symptoms of acute heart failure, hemodynamic compromise, and a new continuous heart murmur. Early surgical repair is highly recommended to prevent acute and long-term complications.

Percutaneous closure versus surgical repair for ruptured sinus of valsalva aneurysm: A systematic review and meta-analysis

Objectives

Ruptured sinus of Valsalva aneurysm (RSVA) often has an abrupt onset, and can chest pain, acute heart failure, and even sudden death. The effectiveness of different treatment modalities remains controversial. Thus, we completed a meta-analysis to evaluate the efficiency and safety of traditional surgery vs. percutaneous closure (PC) for RSVA.

Methods

We carried out a meta-analysis using PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Data, and the China Science and Technology Journal Database. The primary outcome was comparing in-hospital mortality between the two procedures, and the secondary outcome was documenting postoperative residual shunts, postoperative aortic regurgitation, and length of hospital stay in the two groups. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships between predefined surgical variables and clinical outcomes. This meta-analysis was conducted using Review Manager software (version 5.3).

Results

The final qualifying studies included 330 patients from 10 trials (123 in the percutaneous closure group, and 207 in the surgical repair group). When PC was compared to surgical repair, there were no statistically significant differences in in-hospital mortality (overall OR: 0.47, 95%CI 0.05-4.31, P = 0.50). However, percutaneous closure did significantly decrease the average length of hospital stay (OR: -2.13, 95% CI -3.05 to -1.20, P < 0.00001) when compared to surgical repair, but there were no significant between-group differences in the rates of postoperative residual shunts (overall OR: 1.54, 95%CI 0.55-4.34, P = 0.41) or postoperative aortic regurgitation (overall OR: 1.54, 95%CI 0.51-4.68, P = 0.45).

Conclusion

PC may become a valuable alternative to surgical repair for RSVA.

Unruptured sinus of valsalva aneurysm diagnosed by multimodal imaging

We describe a rare case of unruptured right SOVA in a 52-year-old man who was successfully treated with right SOVA repair and right coronary artery reconstruction. Our case demonstrates the usefulness of transthoracic echocardiography, contrastive echocardiography, and transesophageal echocardiography in diagnosing SOVA.

Rupture of the right sinus of Valsalva aneurysm and formation of ventricular septal dissection and third-degree atrioventricular block: A case report

Sinus of Valsalva aneurysm is a rare congenital or acquired cardiac structural abnormality. The sinus of Valsalva aneurysm refers to the local development defect of the aortic sinus wall. Under aortic hypertension, the sinus wall becomes thinner and expands outward. Its clinical manifestations range from asymptomatic to severe life-threatening complications caused by compression or rupture of important surrounding structures. A few cases of aortic aneurysm sinus with arrhythmias have been reported, including complete heart block. Here, we present the case of a 50-year-old male patient with recurrent syncope due to a third-degree atrioventricular block. We found a right sinus of Valsalva aneurysm that ruptured into the basal segment of the interventricular septum and formed a basal septal dissection on echocardiography, which could have caused a third-degree atrioventricular block. This case report highlights the importance of finding secondary etiologies in the sudden or transient onset of third-degree atrioventricular block and using echocardiography to evaluate patients with heart block.

Rupture of sinus of Valsalva aneurysm: a case report in a child

Background

Sinus of Valsalva aneurysm (SVA) is a rare congenital disease that can cause severe clinical presentations when the aneurysm ruptures. Here, we report a rare case of a noncoronary sinus of Valsalva aneurysm with rupture into the right atrium.

Case presentation

A 14-year-old Chinese female patient presented viral myocarditis with acute heart failure at the local hospital, and she was finally diagnosed with a noncoronary sinus Valsalva aneurysm with rupture into the right atrium by digital subtraction angiography with cardiac catheterization angiography and echocardiography at our hospital (Children’s Hospital of Chongqing Medical University). Percutaneous closure intervention was performed shortly after her diagnosis, and the patient showed good functional recovery.

Conclusions

We report a case of ruptured sinus of Valsalva aneurysm successfully treated by percutaneous closure, which is an excellent alternative treatment.

Multilobulated Sinus of Valsalva Aneurysm Dissecting into the Interventricular Septum (DAIS) and Rupturing into Left Ventricle: A Case Report

Background

Dissecting aneurysm of sinus of Valsalva (SOV) into the interventricular septum is a rare entity. Multilobulated form of dissection rupturing into the left ventricle (LV) has never been reported in the literature.

Case summary

A 52-year-old male presented with dyspnoea and palpitation with wide pulse pressure and peripheral signs of distal run-off and a continuous murmur along the left parasternal area. Echocardiography revealed dilated right coronary cusp (RCC), which burrowed into the interventricular septum (IVS), forming multi-loculated cystic lesion which ruptured into LV with associated restrictive ventricular septal defect (VSD) and severe aortic regurgitation. Computed tomography (CT) angiography confirmed a 4.8 cm × 5.3 cm × 5.4 cm multiseptated aneurysm. The surgery involved excision of the aortic valve (AV) with the sinus, ligation of its penetrating portion at the crest of IVS, closure of VSD, and AV replacement. Postoperative echocardiography showed the complete collapse of the IVS component of the SOV aneurysm and the normally functioning mechanical AV.

Discussion

Dissecting aneurysm into the IVS is a rare variant of SOV aneurysm, usually arising from RCC. It is mostly congenital in origin and has wide variety of presentations like congestive heart failure, palpitations, recurrent syncope, chest pain, sudden cardiac arrest, infective endocarditis, cerebral infarction, or asymptomatic. Aortic regurgitation is present in 30–50% of cases. Conduction disturbances from first-degree block to complete heart block are common. Echocardiogram, CT angio, and magnetic resonance imaging are useful for diagnosis. Surgical repair is the only option for treatment.

Acute Rupture of Sinus of Valsalva into Right Atrium: An Echocardiographic Halftone

A ruptured sinus of Valsalva is a rare and emergent cardiac abnormality, which can be acute and rapidly expanding to cause hemodynamic deterioration. Rupturing into right-sided heart chambers causes severe left-to-right shunt and sudden volume overload. Echocardiography especially transesophageal echocardiography (TEE) is the gold standard facility for early perioperative diagnosis and also to guide surgical technique. Medical stabilization followed by prompt surgical intervention is the treatment of choice.

We hereby report a case of sinus of Valsalva rupturing into right atrium leading to severe left-to-right shunt and the role of TEE in its perioperative management.

Case Report: Right Heart Failure Mistaken for Obesity-A Fault of Telemedicine

As a result of the COVID-19 pandemic, telemedicine has become an important branch of healthcare worldwide. Apart from their undeniable advantages, the virtual visits lack physical examination, which can lead to important diagnostic mistakes. We hereby present a case of a pediatric patient whose weight gain, initially attributed to a sedentary lifestyle was, in fact, due to sub-acute right heart failure in the context of a ruptured sinus of Valsalva aneurysm. The condition was not diagnosed until the patient presented at the emergency. The boy was successfully treated with two percutaneous interventions and returned to his previous stature.

Sinus Valsalva Aneurysm of the non-coronary cusp initially diagnosed as right ventricular thrombus: A case report

Sinus of Valsalva aneurysms are abnormal bulges of the aortic root caused by a tissue deficiency resulting in an enlargement of the aortic root in the area between the aortic annulus and the sinotubular junction. Frequently, sinus of Valsalva aneurysms are asymptomatic. However, sinus of Valsalva aneurysms can also be potentially fatal due to their risk of rupture. We present a case of a 49-year old asymptomatic male patient with a rare image of a sinus of Valsalva aneurysm of the non-coronary cusp which was initially mistaken for a right ventricular thrombus. Surgical repair of the sinus of Valsalva aneurysm was eventually achieved by a valve sparing root replacement and the patient was discharged 7 days after surgery. This case report shows that sinus of Valsalva aneurysms are vulnerable to misdiagnosis when it is not initially suspected. Because of the potential fatality of this phenomenon we would like to underline the necessary vigilance in the diagnostic process, as sinus of Valsalva aneurysms can be missed when the physician is not aware of this potential rare diagnosis.

Case Report: Extrinsic Compression of the Left Main Coronary Artery by a Giant Sinus of Valsalva Aneurysm

Sinus of Valsalva aneurysm (SoVA) is an uncommon clinical entity, which is present in roughly 0. 09% of the general population. The cause can either be acquired or congenital. Clinically the SoVA of unruptured status are rarely captured or even diagnosed due to atypical clinical presentations. Here, we present a rare case of exertional angina pectoris and recurrent syncope due to an extrinsically compressed left coronary artery by a giant SoVA in a 50-year-old female patient. This SoVA was successfully repaired by the surgical exclusion and the patient was still doing well after 2 years of follow-up.

A case of ruptured giant sinus of Valsalva aneurysm into the right ventricle in a patient with both atrial and ventricular septal defects

Sinus of Valsalva aneurysm (SOVA) is a rare cardiac defect. In most cases, SOVA presents as an incidental finding during cardiac imaging. A dreadful complication of SOVA is spontaneous rupture, most commonly occurring into the right side of the heart resulting in an abrupt or insidiously progressive congestive heart failure. Ruptured SOVA is associated with poor prognosis with high mortality unless timely surgical intervention is deemed. We present a 23-year-old female who presented with a continuous heart murmur and exertional dyspnea. Transesophageal echocardiogram showed a ruptured 1.8 cm sinus of Valsalva aneurysm of the non-coronary cusp to the right ventricle, which resulted in a significant left-to-right shunt and pulmonary hypertension. Associated cardiac defects included ostium secundum atrial septal defect, peri-membranous ventricular septal defect, and moderate aortic and mitral valve insufficiency. The patient underwent successful surgical correction with significant resolution of the shunt and normalization of the pulmonary pressure. Despite being rare, SOVA can rupture spontaneously, resulting in decompensated heart failure. SOVA should be considered in the differential diagnosis of a continuous heart murmur. Early recognition and timely surgical intervention are pivotal in these cases to prevent further clinical deterioration or even death. LEARNING POINTS: Sinus of Valsalva aneurysms (SOVA) are usually silent until acute rupture. Rupture most commonly occurs into either the right ventricle or right atrium. A new continuous murmur is the most striking physical finding; it is always significant and must prompt urgent echocardiography to facilitate timely diagnosis and treatment. Ruptured SOVA has a poor prognosis with high mortality unless timely surgical intervention is deemed.

Fatal Sinus of Valsalva Aneurysm and Dissection into the Left Ventricle With Extension to the Interventricular Septum: A Challenging Diagnosis

• SVA is a rare condition caused by weakness of elastic lamina. • The right coronary sinus is involved in 67% to 85% of the reported cases. • Clinical features are varied and nonspecific, demanding a high index of suspicion. • Prompt diagnosis with echocardiography is recommended. • Emergent surgical repair should be offered to avoid clinical decompensation.

Surgical Interventions Are Effective for Treating Unruptured Sinus of Valsalva Aneurysms

Background: This study investigates the optimal management for unruptured sinus of Valsalva aneurysms (USVAs) combined with other cardiovascular lesions.

Methods: This retrospective study examined 33 USVA patients who underwent surgical repair from February 1, 2007 to January 31, 2012. We analyzed the surgical procedures and the patients' quality of life after surgery. Additionally, echocardiography follow-up was performed before and after the operation.

Results: Most USVAs (87.8%) originated in the right coronary sinus. Aside from one patient who was preoperatively misdiagnosed as having a ruptured sinus of Valsalva aneurysm (SVA). USVAs of the right coronary sinus were addressed by reinforcing this sinus with a Dacron patch through the right ventricle. USVAs were corrected by aortotomy using an autogenous pericardium patch when they originated in the non-coronary or left coronary sinus. Thirty patients (90.9%) were followed up for 22–119 months. No early death, residual fistula or SVA recurrence were found during the follow-up period. They all had a good quality of life and good heart function (New York Heart Association class I–II).

Conclusions: Active surgical repair of an USVA can be achieved with satisfactory results in patients combined with other cardiovascular lesions.

Ruptured sinus of valsalva aneurysm presenting as syncope and hypotension: a case report

BACKGROUND

Unruptured sinus of valsalva aneurysm (SOVA) are typically asymptomatic, and hence can be easily ignored. Ruptured sinus of valsalva aneurysm (RSOVA) usually protrude into the right atrium or ventricular. However, in this case, the RSOVA protruded into the space between the right atrium and the visceral pericardium leading to compression of the right proximal coronary artery. Very few such cases have been reported till date.

CASE PRESENTATION

We describe a case of ruptured right SOVA in a 61-year-old man with syncope and persistent hypotension. At the beginning, considered the markedly elevated troponin, acute myocardial infarction was considered. However, emergency coronary angiography unexpectedly revealed a large external mass compressed right coronary artery (RCA) resulting in severe proximal stenosis. Then, aorta computed tomography angiography (CTA) and urgent surgery confirmed that the ruptured right SOVA led to external compression of the right proximal coronary artery. Finally, ruptured right SOVA repair and RCA reconstruction were successfully performed, and the patient was discharged with no residual symptoms.

CONCLUSIONS

It is very important to be vigilant about the existence of SOVA. RSOVA should be suspected in a patient presenting with acute hemodynamic compromise, and echocardiography should be immediately performed. Moreover, it is very important to achieve dynamic monitoring by using cardiac color ultrasound. Definitive diagnosis often requires cardiac catheterization, and an aortogram should be performed unless endocarditis is suspected.

An Unusual Cause of Recurrent Syncope: Sinus of Valsalva Aneurysm

Sinus of Valsalva aneurysm (SOVA) is a rare anomaly, commonly caused by the congenital absence of elastic and muscular tissue of the sinus aortic wall. This condition often becomes apparent at the time of rupture. The most recently reported case of syncope in unruptured SOVA was due to Tachy-Brady arrhythmia involving the conduction system. This type of aneurysm also presents with signs and symptoms of ventricular outflow tract obstruction, mimicking ventricular tumor. We report a case of recurrent syncope during exertion resulting from SOVA involving the right coronary cusp, without additional symptoms such as angina, malignant arrhythmias, or infection. The mechanisms remain unknown but may be either the consequence of transient left ventricular outflow tract obstruction or cardiac arrhythmia causing syncope during exertion. This case report presents an unusual cause of syncope and demonstrates a correlation between echocardiography and CT angiography images.

Multimodal imaging of a rare interventricular septum dissecting aneurysm: A case report

We report the case of a patient who presented with chest pain and palpitation, and in whom multimodality imaging, including transthoracic echocardiography, computer tomography angiogram, and coronary angiogram led to the diagnosis of interventricular septum dissecting aneurysm resulting from the rupture of a sinus of Valsalva aneurysm and paravalvular aortic root pseudoaneurysm. The patient underwent the modified Cabrol procedure in the cardiac surgery department. His ruptured sinus of Valsalva aneurysm was repaired and its communication with the pseudoaneurysm was closed. This case report highlights the role of multimodality cardiac imaging.

Ruptured sinus of Valsalva aneurysm: An uncommon presentation of shock to the pediatric emergency department

This case report describes a rare etiology of cardiogenic shock, particularly in the pediatric population. A healthy 17 year old male presents from an outside hospital in undifferentiated shock requiring vasopressor support. Ruptured sinus of Valsalva aneurysm was diagnosed by echocardiogram and the patient went emergently to the operating room for surgical repair. We discuss the anatomy, incidence, and risk factors for sinus of Valsalva aneurysms, along with the range of clinical presentations and Emergency Department management of symptomatic rupture of sinus of Valsalva aneurysms.

Repair of a unique sinus of Valsalva defect in an infant

Sinus of Valsalva aneurysm is a rare disease characterized by the partial elevation of the aortic root. Few reports are available on the surgical treatment for infants. We report the repair of an extremely rare case of a sinus of Valsalva defect with a ventricular septal defect and right ventricular outflow tract stenosis in an infant. It was not a sinus of Valsalva aneurysm, but it exhibited abnormal partial bulging of the aortic root and forming an aneurysm-like cavity within the right ventricular myocardium. We performed direct closure of the sinus of Valsalva aneurysm-like cavities and intracardiac repair in two stages. Three years after total repair, the patient remained healthy and asymptomatic.

Ruptured sinus of Valsalva aneurysm with ventricular septal defect complicated by preoperative cardiogenic shock, cardiac arrest, and multiple organ dysfunction: a rare survivor and review of contemporary literature

Sinus of Valsalva aneurysm (SVA) is a relatively rare cardiac condition, in which the patient is usually asymptomatic. However, once this aneurysm ruptures, patients present with acute symptoms of heart failure. Timely surgical intervention is essential.

We present the case of a 27-year-old woman, who had a ruptured SVA with a ventricular septal defect (VSD). The patient collapsed before the emergency operation and needed cardiopulmonary resuscitation. The patient required preoperative high inotoropic support and postoperative management was difficult because of multiple organ dysfunction. However, the patient recovered after using inhaled nitric oxide and veno-venous hemofiltration and tracheostomy, and was discharged with no further complications. To the best of our knowledge, no such case of a ruptured SVA with VSD, complicated by preoperative cardiac arrest and multiple organ dysfunction that culminated in a successful recovery, has been reported to date.

Sinus of Valsalva aneurysm presenting with chest pain

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.

Sinus of Valsalva Aneurysms: A Review with Perioperative Considerations

The sinuses of Valsalva are outpouchings in the aortic root just distal to the aortic valve that serve several physiologic functions. Aneurysm of this segment of the aorta is quite rare and infrequently encountered in clinical practice. Due to the rarity of sinus of Valsalva aneurysms, there is a lack of controlled trials and most of the literature consists of case reports and series. Here, the authors review the currently available literature to discuss the anatomy and normal function of the aortic root, as well as disease pathology and diagnostic imaging considerations. Using reported cases, the authors also will discuss considerations for cardiac anesthesiologists in the perioperative period.

A challenging case report of acute sinus of Valsalva aneurysm rupture in cardiogenic shock and multi-organ failure with an emphasis on rapid recognition and 'never giving up' in face of futility

Background 

Sinus of Valsalva aneurysm (SoVA) is a rare anomaly and can be divided into acquired and congenital forms, the latter being commonly associated with ventricular septal defects (VSDs). Rupture is a catastrophic complication with high mortality without urgent surgical intervention. We would like to highlight the use of echocardiography in an emergency setting for diagnosis and surgical intervention in a critically ill patient.

Case summary 

We report a 27-year-old female with history of conservatively managed VSD known since childhood. She presented with acute decompensated cardiac failure requiring intubation and inotropic support. Bedside echocardiography performed in the emergency department suggested a ruptured SoVA at the right coronary cusp with underlying supracristal VSD. Despite the patient being critically ill with multi-organ failure, surgery was performed as it was the patient’s best chance for survival. Intraoperative findings tallied with the early echocardiographic results. She recovered gradually and was eventually discharged despite a stormy post-operative period.

Discussion 

This case report highlights the importance of prompt recognition of SoVA rupture by using bedside echocardiography. Surgical intervention needs to be early despite ongoing sepsis in view of acute mechanical failure. This case was unique as it illustrates a successful management of an acutely ill patient with multi-organ failure through early diagnosis, intensive perioperative stabilization, and surgical intervention.

Rupture of the sinus of Valsalva mimicking tricuspid valve vegetation in a healthy, young male adult

A 24-year-old male patient presented with symptoms of acute progressive dyspnea and chest pain. Transthoracic echocardiography demonstrated a mobile mass-like lesion attached to the tricuspid valve, as well as a holodiastolic flow reversal in the descending and abdominal aorta, as increased retrograde flow. We also evaluated the vegetation-like lesion by transesophageal echocardiography. As a result, we were able to diagnose the rupture of the sinus of Valsalva with shunt flow between the aorta and the right heart that had manifested as sudden chest pain and acute dyspnea. The patient underwent surgical repair for this ruptured lesion. After surgery, there was no evidence of residual shunt flow. The objective of this report is to describe a rare presentation of a ruptured sinus of Valsalva and to discuss the importance of adequate diagnosis using advanced imaging modalities. <Learning objective: If the rupture of sinus of Valsalva remains untreated, prognosis could be poor. Prompt diagnosis and timely surgical correction are important, as is further evaluation by transesophageal echocardiography imaging, which could be mandatory for adequate diagnosis.>.

Sinus of Valsalva Aneurysms: Basic Concepts and Imaging Evaluation Using Multidetector Computed Tomography

Sinuses of Valsalva aneurysms are rare cardiac anomalies with a varied clinical spectrum. The presentation may range from silent asymptomatic cases detected incidentally to catastrophic rupture. They are associated with potentially fatal complications; however, the prognosis after treatment is excellent, which mandates prompt and accurate diagnosis. Imaging is of paramount importance in diagnosis, treatment planning, and postsurgical follow-up. Echocardiography remains the initial investigation of choice; however, cardiac magnetic resonance imaging and computed tomography are being increasingly utilized as complementary imaging techniques. The latest generation multidetector computed tomography with its improved spatial and temporal resolution provides high-quality reconstructed images with reduced radiation burden. Moreover, it allows the simultaneous assessment of coronary arteries, thereby helping in mapping the ideal treatment option. Surgical repair remains the treatment of choice with percutaneous closure in selected patients.

A Case of Sinus of Valsalva Aneurysm Rupture in a Patient with Bicuspid Aortic Valve

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SOV-A is defined as abnormal dilation of the aortic root.

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This is a rare entity, with an incidence between 0.14% and 3.5%.

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SOV-A rupture is a complication generating fistulous trajectories between cavities.

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The sign of “windsock” has been described for the ruptured SOV-A.

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We present the case of a ruptured SOV-A in a patient with bicuspid aortic valve.

Rare Presentation of a Ruptured Sinus of Valsalva Aneurysm

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Sinus of Valsalva aneurysm rupture is usually accompanied by heart failure symptoms.

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Infected ruptured Sinus of Valsalva aneurysm is rare.

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In patients without heart failure symptoms, prompt identification is crucial.

Acute rupture of a sinus of Valsalva aneurysm into the right atrium: a case report and a narrative review

Background

Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly which has potential for spontaneous rupture into other cardiac chambers or the pericardial space (depending on its location). A ruptured SVA has a very poor prognosis with high morbidity and mortality. The development of a shunt between the sinus of Valsalva and right-sided cardiac chambers results in a continuous murmur on examination. Our case report is a case of SVA rupture into the right atrium.

Case presentation

In this case report, we describe a 23-year-old patient with an acute onset of chest pain, shortness of breath, palpitations and dizziness starting 2 days prior to presentation to the emergency department. The patient was initially treated for presumed pulmonary embolism overnight while awaiting CTPA the next morning. However, further examination by the inpatient medical team demonstrated a continuous machinery cardiac murmur. Subsequent echocardiography demonstrated an acutely ruptured SVA with shunting to the right atrium. Emergency surgical repair resulted in an excellent outcome for the patient.

Conclusion

A thorough clinical history and physical examination is the cornerstone of all medical encounters. An SVA could be asymptomatic until acute rupture. Echocardiography is the preferred initial diagnostic tool. Additional imaging techniques can be used to confirm the diagnosis. In cases of rupture, prognosis is poor and surgical repair is always required.