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Chaturvedi H, Chaurasia AK, Makkar JS. Transcatheter closure of ruptured sinus of Valsalva type IV with misleading severe aortic regurgitation. J Cardiol Cases 2024; 29:239-243. [PMID: 38826770 PMCID: PMC11143718 DOI: 10.1016/j.jccase.2024.02.002] [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: 06/09/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 06/04/2024] Open
Abstract
We present an unusual case of ruptured sinus of Valsalva (RSOV) in the right atrium, progressive exertional dyspnea, occasional epigastric heaviness, and palpitations. The examination revealed high-pitch continuous murmur. On transthoracic echocardiography, there was a ~5-6 mm size RSOV of non-coronary sinus into right atrium, continuous turbulent flow, and unusual presentation of severe central aortic regurgitation jet with holodiastolic flow reversal seen in the descending aorta. The sinus of Valsalva aneurysm is a rare pathology, which is generally asymptomatic. In this case it manifested through a rupture into the right atrium and needed to be closed to relieve the symptoms. Transcathter closure of RSOV was done by using Amplatzer duct occluding device, there was no residual shunt, and aortic regurgitation completely disappeared. Learning objective This is a unique case in which ruptured sinus of Valsalva flow and holodiastolic flow reversal were confused with severe aortic regurgitation. Careful and detailed transthoracic echocardiography played a key role in correct diagnosis and proper management.
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Patel M, Patel K, Gajjar T, Mishra A. Aneurysms of Aortic Sinus of Valsalva Dissecting through the Interventricular Septum With Rupture into the Left Ventricle: Case Series and Literature Review. World J Pediatr Congenit Heart Surg 2024; 15:340-348. [PMID: 38646718 DOI: 10.1177/21501351241241322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Aneurysm of Aortic sinus of Valsalva (ASOV) dissecting into the interventricular septum (IVS) and rupturing into the left ventricle (LV) is a rare clinical diagnosis. Systemic inflammatory diseases like tuberculosis can aggravate this condition. We describe three cases of ASOV dissecting into the IVS and rupturing into the LV. All three patients underwent surgical intervention; two had a successful outcome. A literature review was conducted and19 previously reported cases were studied. The extent and direction of septal dissection determined the associated cardiac valvular and rhythm problems. Patch closure of the mouth of the aneurysm is the surgical method of choice. In the presence of multiple sinus tracts or if there is recurrence after surgical closure, aortic sinus or root replacement techniques have better outcomes.
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Affiliation(s)
- Mrinal Patel
- Department of Surgery (Hospital of University of Pennsylvania), University of Pennsylvania, Philadelphia, PA, USA
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College), Ahmedabad, Gujarat, India
| | - Kartik Patel
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College), Ahmedabad, Gujarat, India
| | - Trushar Gajjar
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College), Ahmedabad, Gujarat, India
| | - Amit Mishra
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College), Ahmedabad, Gujarat, India
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Bigg H, Bolin E, Zakaria D, Bornemeier R. Ruptured Sinus of Valsalva Aneurysm with Resultant Myocardial Pouch Formation in the Fetal Heart-A Diagnostic Challenge. J Cardiovasc Dev Dis 2024; 11:23. [PMID: 38248893 PMCID: PMC10816109 DOI: 10.3390/jcdd11010023] [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: 12/12/2023] [Revised: 01/01/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
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.
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Affiliation(s)
- Hugh Bigg
- Division of Pediatric Cardiology, University of Utah, Primary Children’s Hospital, #100 Mario Capecchi Dr., Salt Lake City, UT 84113, USA
| | - Elijah Bolin
- Section of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children’s Hospital, #1 Children’s Way, Slot 512-3, Little Rock, AR 72202, USA
| | - Dala Zakaria
- Section of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children’s Hospital, #1 Children’s Way, Slot 512-3, Little Rock, AR 72202, USA
| | - Renee Bornemeier
- Section of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children’s Hospital, #1 Children’s Way, Slot 512-3, Little Rock, AR 72202, USA
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Mao Y, Wang C, Li Y, Guan X, Zhang X, Wu X. Percutaneous closure versus surgical repair for ruptured sinus of valsalva aneurysm: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1158906. [PMID: 37139136 PMCID: PMC10150332 DOI: 10.3389/fcvm.2023.1158906] [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: 02/04/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
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.
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Affiliation(s)
- Yong Mao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Cingting Wang
- Health Science Center of Lanzhou University, Lanzhou University, Lanzhou, China
- Dongguan Tungwah Hospital, Dongguan, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xinqiang Guan
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xiaopeng Zhang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xiangyang Wu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Correspondence: Xiangyang Wu
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Jain A, Achuthan G. Rupture of Sinus of Valsalva Aneurysm into Interventricular Septum: Role of Cardiac CT. Cureus 2019; 11:e5589. [PMID: 31696007 PMCID: PMC6820894 DOI: 10.7759/cureus.5589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sinus of Valsalva aneurysm dissecting and forming sinus tract into interventricular septum is an extremely rare complication of sinus of Valsalva aneurysm. Echocardiography and conventional angiography were used earlier to diagnose ruptured sinus of Valsalva aneurysm. Cardiac CT has emerged as a valuable non-invasive diagnostic tool for evaluation of complications of sinus of Valsalva aneurysm. In this article, we report two cases of ruptured sinus of Valsalva aneurysm arising from right and left coronary sinuses into the interventricular septum without aorto-cardiac shunt formation evaluated using 256 slice cardiac CT imaging. After diagnosis on cardiac CT, these findings were confirmed perioperatively and were repaired surgically.
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Slautin A, Mikulenka V, Hlubocký J, Novotný R, Špaček M, Vondráček V, Lindner J. Ruptured non-coronary sinus of Valsalva aneurysm into the right atrium in 44-year-old patient. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gu X, He Y, Luan S, Zhao Y, Sun L, Zhang H, Nixon JI. Dissection of the interventricular septum: Echocardiographic features. Medicine (Baltimore) 2017; 96:e6191. [PMID: 28272209 PMCID: PMC5348157 DOI: 10.1097/md.0000000000006191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Dissection of the interventricular septum (IVS) is an extremely rare entity. An institutional echocardiographic database was retrospectively reviewed; 13 patients with a diagnosis of IVS dissection were found and confirmed by cardiac surgery. The purposes of the study were: to determine the value of transthoracic echocardiography (TTE) in establishing the diagnosis of IVS dissection, and to detail the TTE features of IVS dissection.Thirteen patients with IVS dissection diagnosed by TTE, 8 males and 5 females were taken from 789,114 TTE studies performed between 1985 and 2014. All underwent cardiac surgery during which their diagnosis was confirmed. The etiology, location, 2-dimensional morphology, and color Doppler findings of IVS dissection were noted.The right sinus of Valsalva (SOV) was involved in 11 of the 13 patients. In 5 patients, a single aneurysm of the right SOV was seen dissecting into the IVS. One patient with a combination of a bicuspid aortic valve and a right SOV aneurysm dissected into the IVS. In 4 patients, aortic valve infective endocarditis resulted in IVS dissection. In 1 patient, mechanical aortic valve prosthetic replacement was complicated by annular detachment and a severe paravalvular leak causing IVS dissection. In all 11 patients, TTE showed a dissecting cystic-like mass in the IVS from the base to the mid-septum or confined to the septal base. The path of the dissection in these 11 patients was traced to the right SOV and communications between the IVS dissection and the aortic root were identified. In the remaining 2 patients, IVS dissection followed septal rupture due to a myocardial infarction, and communication was seen between the IVS dissection and the right ventricle.The study showed that most of the dissections of the IVS commence in the right SOV, due to either congenital anomalies or infective endocarditis, or following aortic valve replacement or myocardial infarction. The TTE characteristic of IVS dissection is a cystic-like mass seen in the IVS.
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Affiliation(s)
- Xiaoyan Gu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Yihua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Shurong Luan
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Ying Zhao
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Lin Sun
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | | | - J.V. Ian Nixon
- The Pauley Heart Center, Virginal Commonwealth University School of Medicine, Richmond, VA, USA
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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.
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Affiliation(s)
- Michael Weinreich
- Department of Medicine, North Shore-Long Island Jewish Health System/Hofstra University School of Medicine, Manhasset, New York
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Jang YJ, Kim JY, Lee KB, Na GW, Lee WJ, Park WI, Lee M. Spontaneous perforation and dissection of the sinus of Valsalva and interventricular septum with intracardiac thrombus in a patient with Behcet's disease. Korean J Intern Med 2015; 30:252-5. [PMID: 25750569 PMCID: PMC4351334 DOI: 10.3904/kjim.2015.30.2.252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/22/2014] [Accepted: 08/20/2014] [Indexed: 02/07/2023] Open
Affiliation(s)
- Yoon-Jung Jang
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Young Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyung Been Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Gun Wung Na
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Won Jae Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Won Il Park
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Mirae Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Chikkabasavaiah NA, Patra S, Basavappa R, Puttegowda B, Khateeb STA, Nanjappa MC. Large unruptured sinus of valsalva aneurysm dissecting into interventricular septum and presenting as a complex myocardial cystic mass. Echocardiography 2014; 31:E207-11. [PMID: 24813305 DOI: 10.1111/echo.12616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Unruptured aneurysm of sinus of Valsalva (SOV) is extremely rare. They may be asymptomatic and diagnosed incidentally or can present with either fatal outcome following rupture or manifest acutely with compression of surrounding structures. Dissection of unruptured aneurysm of left SOV into interventricular septum (IVS) and presenting as intramyocardial mass is not reported in the literature. We are reporting a case of 21-year-old man who was referred to us following a seizure episode and was incidentally diagnosed with aneurysm of left SOV dissecting into IVS. Multimodality imaging confirmed the diagnosis. He successfully underwent surgical repair and was asymptomatic during follow-up.
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