A case of ruptured sinus of Valsalva aneurysm and reversible flow-induced pulmonary hypertension

Pulmonary hypertension (PH) in adults with congenital heart disease (CHD) and significant systemic-to-pulmonary shunting is a significant cause of morbidity and mortality. Its pathophysiology is incompletely understood, but involves a flow-induced pulmonary arteriopathy characterized by endothelial cell dysfunction and vascular remodeling that alters pulmonary arterial vasoreactivity. There is a paucity of literature linking PH with left-to-right shunting due to ruptured sinus of Valsalva aneurysms (SOVA). We present a unique case of reversible, flow-associated PH due to a ruptured congenital right SOVA fistulizing into the right atrium (RA), with emphasis on non-invasive and invasive assessment of pulmonary hemodynamics before and after surgical intervention.

Chest pain in adult congenital heart disease: where does it come from?

Chest pain is common in adolescents and in young adults and usually not associated with a severe underlying cardiovascular disorder. However, in adults with congenital heart disease, residua or sequellae of previous interventions may provoke potential complications. Moreover, chest pain may be the first sign of a life-threatening condition. Basic knowledge is mandatory and will lead to the correct diagnosis and treatment. Data in literature, which focus on this issue, are scarce and motivated to summarize the experience of daily practice from the eye point of the clinician.