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Kim WK, Eckel C, Charitos EI, Renker M, Grothusen C, Choi YH, Hamm C, Blumenstein J, Sossalla S, Möllmann H. Risk Assessment Of Coronary Obstruction For The ACURATE Transcatheter Heart Valve. Am J Cardiol 2024; 213:45-46. [PMID: 38042270 DOI: 10.1016/j.amjcard.2023.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Won-Keun Kim
- Departments of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Departments of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany; Rhein-Main Partner Site, German Center for Cardiovascular Research (DZHK), Bad Nauheim, Germany.
| | - Clemens Eckel
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany; Department of Internal Medicine, Carl von Ossietzky University, Oldenburg, Germany
| | | | - Matthias Renker
- Departments of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Departments of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; Rhein-Main Partner Site, German Center for Cardiovascular Research (DZHK), Bad Nauheim, Germany
| | | | - Yeong-Hoon Choi
- Departments of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; Rhein-Main Partner Site, German Center for Cardiovascular Research (DZHK), Bad Nauheim, Germany
| | - Catharina Hamm
- Departments of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Rhein-Main Partner Site, German Center for Cardiovascular Research (DZHK), Bad Nauheim, Germany
| | - Johannes Blumenstein
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany; Department of Internal Medicine, Carl von Ossietzky University, Oldenburg, Germany
| | - Samuel Sossalla
- Departments of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany; Rhein-Main Partner Site, German Center for Cardiovascular Research (DZHK), Bad Nauheim, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
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Barua A, Nanjaiah P, Warwick R, Jeeji R, Balacumaraswami L. A customized technique for confluent aortic annular and selective sinus of Valsalva endocarditis. J Surg Case Rep 2024; 2024:rjae089. [PMID: 38404448 PMCID: PMC10894697 DOI: 10.1093/jscr/rjae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/04/2024] [Indexed: 02/27/2024] Open
Abstract
We describe a novel technical modification for reoperative aortic valve replacement in destructive recurrent prosthetic aortic valve endocarditis. We encountered complex anatomy in a previously operated aortic root wherein the aortic annulus and the right coronary sinus of Valsalva were destroyed. This precluded secure suture placement. We modified a composite mechanical Valsalva conduit to create a separate sinus of Valsalva left in continuity with the mechanical valve. This approach allowed us to exclude the infected right sinus of Valsalva and the corresponding aortic annulus.
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Affiliation(s)
- Anupama Barua
- Department of Cardiothoracic Surgery, University Hospitals North Midlands NHS Trust, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
| | - Prakash Nanjaiah
- Department of Cardiothoracic Surgery, University Hospitals North Midlands NHS Trust, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
| | - Richard Warwick
- Department of Cardiothoracic Surgery, University Hospitals North Midlands NHS Trust, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
| | - Ravish Jeeji
- Department of Cardiothoracic Anaesthesia, University Hospitals North Midlands NHS Trust, Staffordshire, United Kingdom
| | - Lognathen Balacumaraswami
- Department of Cardiothoracic Surgery, University Hospitals North Midlands NHS Trust, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Corona-Rivera JR, Barrios-Prieto E, Rivera-Ramírez B, Sánchez-Uribe EH, Cortés-Pastrana RC, Aguilera CER, de Anda-Camacho RG, Peña-Padilla C, Bobadilla-Morales L, Corona-Rivera A. Aneurysms involving the coronary arteries in a neonate with neurofibromatosis 1. Am J Med Genet A 2023; 191:2422-2427. [PMID: 37278515 DOI: 10.1002/ajmg.a.63321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/01/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
Aneurysmal coronary artery disease (ACAD) has been reported rarely in patients with neurofibromatosis type 1 (NF1), mostly in adults. We report on a female newborn affected by NF1 with ACAD disclosed during investigation for an abnormal prenatal ultrasound along with a review of the previously reported cases. The proposita had multiple café-au-lait spots and had no cardiac symptoms. Echocardiography, and cardiac computed tomography angiography confirmed aneurysms on the left coronary artery, left anterior descending coronary artery, and of the sinus of Valsalva. Molecular analysis detected the pathogenic variant NM_001042492.3(NF1):c.3943C>T (p.Gln1315*). Literature findings on ACAD in NF1 indicated that this mostly occurs in males, showing predilection for the development of aneurysms at the left anterior descending coronary artery, and manifesting predominantly as acute myocardial infarction, inclusively in teenagers, though it may be also asymptomatic as in our case. This report documents the first case of ACAD in a patient with NF1 diagnosed at birth, emphasizing that its early diagnosis is essential to prevent potential life-threatening events attributable directly to coronary lesions.
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Affiliation(s)
- Jorge Román Corona-Rivera
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetic Unit, Pediatric Division, 'Dr. Juan I. Menchaca' Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
- 'Dr. Enrique Corona Rivera' Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Centre, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Ernestro Barrios-Prieto
- Department of Maternal-Fetal Medicine, 'Dr. Juan I. Menchaca' Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Berenice Rivera-Ramírez
- Service of Cardiology, Pediatric Division, 'Dr. Juan I. Menchaca' Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Enndy Hollyver Sánchez-Uribe
- Service of Radiology and Imaging, 'Dr. Juan I. Menchaca' Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Rocío Carolina Cortés-Pastrana
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetic Unit, Pediatric Division, 'Dr. Juan I. Menchaca' Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | - Christian Peña-Padilla
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetic Unit, Pediatric Division, 'Dr. Juan I. Menchaca' Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Lucina Bobadilla-Morales
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetic Unit, Pediatric Division, 'Dr. Juan I. Menchaca' Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
- 'Dr. Enrique Corona Rivera' Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Centre, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Alfredo Corona-Rivera
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetic Unit, Pediatric Division, 'Dr. Juan I. Menchaca' Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
- 'Dr. Enrique Corona Rivera' Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Centre, University of Guadalajara, Guadalajara, Jalisco, Mexico
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Yuge N, Manabe S, Sugimura K, Shimokawa H. Localized dissection of the sinus of valsalva mimicking spontaneous coronary artery dissection. Interdiscip Cardiovasc Thorac Surg 2023:7192178. [PMID: 37289552 DOI: 10.1093/icvts/ivad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/09/2023] [Accepted: 06/07/2023] [Indexed: 06/10/2023]
Abstract
A 56-year-old man, suspected of having ST-segment elevation myocardial infarction due to spontaneous coronary artery dissection, underwent emergent percutaneous coronary intervention. Although he had moderate aortic regurgitation with aortic root dilation and mild heart failure, it was controlled with medications. Two weeks after discharge, he was readmitted with severe heart failure due to severe aortic regurgitation and underwent aortic root replacement. Intraoperative findings revealed that localized dissection of the sinus of Valsalva involved the right coronary artery, resulting in a coronary artery dissection. Therefore, in cases of spontaneous coronary artery dissection, attention should be paid to coronary artery dissection caused by localized aortic root dissection.
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Affiliation(s)
- Norihisa Yuge
- Department of Cardiovascular Surgery, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Susumu Manabe
- Department of Cardiovascular Surgery, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Koichiro Sugimura
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Hiroaki Shimokawa
- Graduate School, International University of Health and Welfare, Chiba, Japan
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Ayati A, Toofaninejad N, Hosseinsabet A, Hosseini K, Hajizeinali A. Transcatheter closure of ruptured sinus of Valsalva: A report of first five cases in Tehran Heart Center, Iran. Clin Case Rep 2023; 11:e7036. [PMID: 36895508 PMCID: PMC9989363 DOI: 10.1002/ccr3.7036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/08/2023] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
Ruptured sinus of Valsalva (RSOV) is a potentially lethal lesion requiring prompt intervention. Transcatheter Closure of RSOV is a novel alternative to the standard treatment, which is open-heart surgery. In this case series, we have reported our center's first five cases of RSOV patients undergoing Transcatheter Closure.
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Affiliation(s)
- Aryan Ayati
- Cardiology Department, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Neda Toofaninejad
- Cardiology Department, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Kaveh Hosseini
- Cardiology Department, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Alimohammad Hajizeinali
- Cardiology Department, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
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Dudkiewicz D, Zhingre Sanchez JD, Hołda J, Bolechała F, Strona M, Kopacz P, Iaizzo PA, Koziej M, Hołda MK, Konieczyńska M. Aortic valve fenestrations: Macroscopic assessment and functional anatomy study. Clin Anat 2023; 36:612-617. [PMID: 36597994 DOI: 10.1002/ca.24002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
Aortic valve fenestrations are defined as a loss of aortic valve leaflet tissue. They are a common but overlooked finding with unclear significance. The aim of this study was to investigate the varied functional anatomies of aortic valve fenestrations. A total of 400 formalin-fixed autopsied human hearts were macroscopically assessed and the function of the aortic valve of 16 reanimated human hearts were imaged using Visible Heart® methodologies. Aortic valve leaflet fenestrations were present in 43.0% of autopsied hearts (in one leaflet in 24.0%, in two leaflets 16.0%, in all leaflets 3.0%). Fenestrations were mostly present in left (25.5%) followed by right (23.3%) and noncoronary leaflet (16.3%). In 93.8% of cases, the fenestrations form clusters and were mainly located at the free edge of the leaflet in the commissural area (95.4%). Hearts with aortic valve fenestrations had significantly larger aortic valve diameters and aortic valve areas (p < 0.001). The average surface area sizes of fenestrations were 23.8 ± 16.6 mm2 , and the areas were largest for left followed by right and noncoronary leaflet fenestrations (p < 0.001). The fenestration areas positively correlated with donor age (r = 0.31; p = 0.02). Significant hypermobility and subjective weakening of the leaflet adhesion levels of the fenestrated regions were observed. In conclusion, fenestrations of the aortic leaflets are frequent, and their sizes may be significant. They occur in all age groups, yet their size increase with aging. Fragments of leaflets with fenestrations show different behaviors during the cardiac cycle versus unchanged areas.
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Affiliation(s)
- Damian Dudkiewicz
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jorge D Zhingre Sanchez
- Visible Heart® Laboratories, Departments of Biomedical Engineering and Surgery, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Kopacz
- Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paul A Iaizzo
- Visible Heart® Laboratories, Departments of Biomedical Engineering and Surgery, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mateusz Koziej
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Department of Diagnostic Medicine, John Paul II Hospital, Kraków, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Małgorzata Konieczyńska
- Department of Diagnostic Medicine, John Paul II Hospital, Kraków, Poland.,Department of Thromboembolic Diseases, Jagiellonian University Medical College, Cracow, Poland
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Zhang S, Xu Z, Zou C, Zhang G. Dysphagia Caused by the Unruptured Aneurysm in the Left Sinus of Valsalva. Circ Cardiovasc Imaging 2022; 15:e013952. [PMID: 35652340 DOI: 10.1161/circimaging.122.013952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shijie Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (S.Z., C.Z., G.Z)
| | - Zhenqiang Xu
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China (Z.X., C.Z., G.Z)
| | - Chengwei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (S.Z., C.Z., G.Z).,Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China (Z.X., C.Z., G.Z)
| | - Gang Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (S.Z., C.Z., G.Z).,Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China (Z.X., C.Z., G.Z)
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Tarantini G, Nai Fovino L, Scotti A, Massussi M, Cardaioli F, Rodinò G, Benedetti A, Boiago M, Matsuda Y, Continisio S, Montonati C, Cacciavillani L, Pavei A, Masiero G, Napodano M, Fraccaro C, Fabris T, Iliceto S. Coronary Access After Transcatheter Aortic Valve Replacement With Commissural Alignment: The ALIGN-ACCESS Study. Circ Cardiovasc Interv 2022; 15:e011045. [PMID: 35167332 DOI: 10.1161/circinterventions.121.011045] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Coronary access (CA) after transcatheter aortic valve replacement (TAVR) with supra-annular transcatheter heart valves (THV) can be challenging. Specific Evolut R/Pro and Acurate Neo THVs orientations are associated with reduced neo-commissure overlap with coronary ostia, while SAPIEN 3 THV cannot be oriented. With the ALIGN-ACCESS study (TAVR With Commissural Alignment Followed by Coronary Access), we investigated the impact of commissural alignment on the feasibility of CA after TAVR. METHODS We performed coronary angiography after TAVR with intra-annular SAPIEN 3, supra-annular Evolut R/Pro, and Acurate Neo THVs in 206 patients. Evolut THVs were implanted aiming for commissure alignment. Alignment of Acurate Neo was retrospectively assessed in 36, intentionally attempted in 26 cases. The primary end point was the rate of unfeasible and nonselective CA after TAVR. RESULTS Thirty-eight percent of patients received SAPIEN 3, 31.1% Evolut Pro/R, 30.1% Acurate Neo THV. Final valve orientation was favorable to commissural alignment in 85.9% of Evolut and 69.4% of Acurate Neo cases (with intentional alignment successful in 88.5%). Selective CA was higher for SAPIEN 3 than for aligned and misaligned supra-annular THVs (95% versus 71% versus 46%, P<0.001). Cannulation of at least one coronary was unfeasible with 11% misaligned supra-annular, 3% aligned supra-annular, and 0% SAPIEN 3 THVs. Independent predictors of unfeasible/nonselective CA were implantation of a misaligned supra-annular THV (odds ratio, 4.59 [95% CI, 1.81-11.61]; P<0.01), sinus of Valsalva height (odds ratio, 0.83 [95% CI, 0.7-0.98]; P=0.03), and THV-sinus of Valsalva relation (odds ratio, 1.06 [95% CI, 1.02-1.1]; P<0.01). CONCLUSIONS Commissural alignment improves the rate of selective CA after TAVR with supra-annular THVs. Nevertheless, aligned supra-annular THVs carry higher risk of unfeasible/nonselective CA than SAPIEN 3. Patients with a misaligned supra-annular THV, low sinus of Valsalva, and higher THV-sinus of Valsalva relation are at highest risk of impaired CA after TAVR.
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Affiliation(s)
| | | | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Alice Benedetti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Mauro Boiago
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Yuji Matsuda
- Department of Cardiovascular Medicine, Graduate School of General Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan (Y.M.)
| | - Saverio Continisio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Carolina Montonati
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Luisa Cacciavillani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Andrea Pavei
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Massimo Napodano
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (G.T., L.N.F., A.S., M.M., F.C., G.R., A.B., M.B., S.C., C.M., L.C., A.P., G.M., M.N., C.F., T.F., S.I.)
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10
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Jalili Shahandashti F, Saedi S, Pouraliakbar HR. Incidental detection of ruptured sinus of Valsalva aneurysm and coronary abnormality in a patient with penetrating chest trauma. Echocardiography 2022; 39:387-389. [PMID: 35034384 DOI: 10.1111/echo.15293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/17/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022] Open
Abstract
Aortic sinus of Valsalva aneurysm is a rare congenital or acquired anomaly with a potential for rupture into adjacent cardiac chambers. Ruptured aneurysm of the sinus of Valsalva leads to volume overload of the receiving chamber and should be repaired as soon as the diagnosis is made. Here, we present a young patient with history of chest trauma leading to discovery of an asymptomatic ruptured sinus of Valsalva aneurysm.
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Affiliation(s)
| | - Sedigheh Saedi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Pouraliakbar
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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11
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Wei HQ, Guo XG, Zhou GB, Sun Q, Yang JD, Xie HY, Liang J, Zhang S, Wu S, Ma J. Predictors and Long-Term Outcome of Ablation of Discrete Pre-potentials in Patients With Idiopathic Ventricular Arrhythmias Originating From the Aortic Sinuses of Valsalva. Front Cardiovasc Med 2021; 8:767514. [PMID: 34950714 PMCID: PMC8688708 DOI: 10.3389/fcvm.2021.767514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The predictability and long-term outcome of the discrete pre-potential (DPP) of idiopathic ventricular arrhythmias (VAs) arising from the aortic sinuses of Valsalva (ASV) have not been fully identified. Methods: Of 687 consecutive patients undergoing ablation of outflow tract VAs, there were 105 (15.3%) patients with VAs originating from the ASV region who were included. Detailed mapping was performed within the ASV in all patients. Electrocardiographic, electrophysiological parameters, and long-term success rate were compared between patients with and without the DPPs. Results: A DPP was recorded in 67 of 105 (63.8%) patients, including 38 left sinus of Valsalva (LSV)-VAs (38/105, 36.2%) and 29 right sinus of Valsalva (RSV)-VAs (29/105, 27.6%). The patients with DPPs had wider QRS duration (152 ± 17 vs. 145 ± 14 ms, p < 0.001). The average of earliest activation time was significantly earlier in patients with DPPs (−38.6 ± 8.5 vs. −27.7 ± 5.7 ms, p < 0.001). Mean time from the first lesion to elimination of VAs was shorter in patients with DPPs (2.3 ± 2.1 s vs. 4.9 ± 1.0 s, p < 0.001). A stepwise logistic multivariable analysis identified only younger age as a significant predictor of DPP (age ≤ 35.5 years predicted DPP with 92.9% positive predictive value). During a follow-up duration of 42.5 ± 22.3 months, 63 (94.0%) patients with DPPs and 30 (78.9%) patients without DPPs remained free of recurrent VAs (p = 0.027). Conclusion: Discrete pre-potentials were observed in 63.8% of patients with VAs arising from the ASV. Ablation in patients with DPPs was associated with higher long-term success. DPPs were seen more commonly in younger (age ≤ 35.5 years) patients.
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Affiliation(s)
- Hui-Qiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Yang Xie
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jackson Liang
- Division of Cardiovascular Medicine, Electrophysiology Service, University of Michigan Health System, Ann Arbor, MI, United States
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Kashimada W, Fujioka T, Kobayashi J. Pseudoaneurysm of the sinus of Valsalva caused by infective endocarditis in a 7-year-old child with congenital heart disease. Cardiol Young 2021; 31:1532-4. [PMID: 33787476 DOI: 10.1017/S1047951121001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a case of a pseudoaneurysm in the sinus of Valsalva, secondary to infective endocarditis in a child with trisomy 21. The patient had a history of subaortic stenosis, bicuspid aortic valve, and ventricular septal defect. Patch closure of the ostium of the pseudoaneurysm and aortic valve replacement was performed. The patient was discharged without severe complications.
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13
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Aboukhoudir F, Jaussaud N, Rekik S, Pankert M. [Ruptured sinus of Valsalva aneurysm presenting as an idiopathic pericardial effusion]. Ann Cardiol Angeiol (Paris) 2021; 70:360-366. [PMID: 34452732 DOI: 10.1016/j.ancard.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
Aneurysm of the sinus of Valsalva is a rare cardiac condition, which could be either acquired or congenital. The most frequent complication is a rupture into right cavities or more rarely into left cavities or pericardium. Rupture could be either asymptomatic or poorly tolerated with hemodynamic instability, acute heart failure or sudden death. We report the case of a 24-year-old patient with no past medical history presenting with a partially ruptured sinus of Valsalva into the pericardium and in whom the initial diagnosis was idiopathic pericardial effusion; we describe diagnostic modalities and management.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France; Avignon université EA4278 laboratoire de pharm Écologie cardiovasculaire, Avignon, France.
| | - N Jaussaud
- Département chirurgie cardiaque,CHU La Timone, APHM ,Marseille,France
| | - Sofiéne Rekik
- Service de cardiologie, centre hospitalier Nord Franche comté, Belfort, France.
| | - Mathieu Pankert
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
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14
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Ghannam M, Liang JJ, Attili A, Cochet H, Jais P, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Cardiac Magnetic Resonance Imaging and Ventricular Tachycardias Involving the Sinuses of Valsalva in Patients With Nonischemic Cardiomyopathy. JACC Clin Electrophysiol 2021; 7:1243-1253. [PMID: 34217653 DOI: 10.1016/j.jacep.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The goal of this study was to investigate the relationship between cardiac scar on late gadolinium enhancement cardiac resonance imaging (LGE-CMR) and the presence of ventricular tachycardia (VT) ablation target sites within the sinuses of Valsalva (SV). BACKGROUND Patients with idiopathic dilated cardiomyopathy (IDCM) often have scarring involving the basal myocardium, including the SV, allowing targeting of VTs from within the SV. METHODS Forty-three consecutive patients with IDCM underwent a VT ablation procedure with pre-procedure LGE-CMR. Retrospectively, scar characteristics were compared between patients with and without VT target sites in the SV. The ratio between SV-related scarring and the total cardiac scarring was defined as the SV scar index: SV-related scarring/total cardiac scarring. RESULTS VT target sites were identified in the SV in 22 (51%) of 43 patients. LGE-CMR identified peri-aortic scarring involving the SV in 34 patients (79%). Scarring extended to the septum in 26 patients, involved the lateral basal wall in 4, and both areas in 13 patients. Scar volume within the SV was larger in patients with SV-VT targets (1.7 ± 0.9 cm3 vs. 0.7 ± 0.6 cm3; p < 0.0001) compared with other patients. A cutoff scar volume identifying SV-VT targets was 1.23 cm3 in the short-axis view (area under the curve 0.82; sensitivity 0.64; specificity 0.91). The SV scar index was significantly greater in patients who had SV-VT target sites (0.33 ± 0.2 vs. 0.09 ± 0.09; p < 0.0001). CONCLUSIONS Patients with IDCM undergoing ablation of VT often have peri-aortic scarring visualized on LGE-CMR. Both the presence and the extent of scarring adjacent to the aortic annulus are associated with the presence of VT target sites within the SV.
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Affiliation(s)
- Michael Ghannam
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jackson J Liang
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anil Attili
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hubert Cochet
- Bordeaux University Hospital and University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | - Pierre Jais
- Bordeaux University Hospital and University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Fred Morady
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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15
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Li X, Zhong Y, Rao L, Bai W. A dissecting aneurysm of the sinus of Valsalva involving the inter-ventricsular septum in a patient with syphilis and a quadricuspid aortic valve. Echocardiography 2021; 38:1061-1063. [PMID: 33929064 DOI: 10.1111/echo.15055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/08/2021] [Accepted: 04/04/2021] [Indexed: 02/05/2023] Open
Abstract
Aneurysms of the sinus of Valsalva are rare, with dissecting aneurysms of the sinus of Valsalva that extend into the inter-ventricular septum being even more rare. This report describes a young patient with syphilis and a quadricuspid aortic valve who experienced a spontaneously dissecting aneurysm of the sinus of Valsalva and the basal inter-ventricular septum.
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Affiliation(s)
- Xiang Li
- Cardiology Department, West China Hospital, Sichuan University, China
| | - Yue Zhong
- Cardiology Department, West China Hospital, Sichuan University, China
| | - Li Rao
- Cardiology Department, West China Hospital, Sichuan University, China
| | - Wenjuan Bai
- Cardiology Department, West China Hospital, Sichuan University, China
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16
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Jaswal V, Kumar V, Thingnam SKS, Puri GD. Surgical repair of ruptured sinus of Valsalva aneurysm: 13-year single center experience. J Card Surg 2021; 36:1264-1269. [PMID: 33476446 DOI: 10.1111/jocs.15358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Untreated ruptured sinus of Valsalva aneurysms ultimately develop into heart failure, thereby affecting patients' survival. We retrospectively analyzed our 13-year experience of the surgical repair for ruptured sinus of Valsalva aneurysm to study the optimal surgical strategy, operative risk and long-term surgical outcome. METHODS Twenty-six patients underwent surgical repair of ruptured sinus of Valsalva aneurysm from January 2008 to February 2020. Follow-up data were obtained from the outpatient department records and telephone calls. RESULTS Patch closure of ruptured sinus of Valsalva aneurysm was done in all the 26 patients, most often through the transaortic (69%) and dual-chamber approach (23%). Aortic valve repair was done in one patient while seven patients underwent aortic valve replacement for associated significant aortic regurgitation. There was one in-hospital mortality because of noncardiac cause. The median duration of postoperative hospital stay was 8 days (range, 6-11 days). Follow-up data were available for 89% (23/26) patients. The mean follow-up period was 69 ± 43 months (range, 7-147 months). All survivors were in New York Heart Association functional Class I or II. There was no late death. One patient required rehospitalization for recurrent ruptured sinus of Valsalva aneurysm. There was no recurrent or new-onset significant aortic regurgitation and prosthesis-related complications in late follow-up. CONCLUSION Surgical repair for ruptured sinus of Valsalva aneurysm carries an acceptable low operative risk and excellent long-term outcome. Though high-risk population, an early diagnosis and optimal surgical approach can prevent worsening of symptoms and consequent heart failure.
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Affiliation(s)
- Vivek Jaswal
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Kumar
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam K S Thingnam
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan D Puri
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Gong X, Wang J, Wei L, Zhao T, Hu S. Case Report: Transcatheter Closure of Ruptured Sinus of Valsalva With Ventricular Septal Defect Occluder in a 3-Year-Old Child After Repair of Ventricular Septal Defect. Front Pediatr 2021; 9:751163. [PMID: 34660497 PMCID: PMC8514821 DOI: 10.3389/fped.2021.751163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023] Open
Abstract
Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that can undergo spontaneous rupture into other cardiac chambers or the pericardial space. A ruptured SVA has a very poor prognosis with high morbidity and mortality. These aneurysms often present as a rupture from the right coronary sinus into the right ventricle. Transcatheter closure has become an effective alternative to surgical treatment. However, it has been rarely reported in patients after ventricular defect repair in the past. We here describe a 3-year-and-3-month-old boy who was found to have a ruptured sinus of Valsalva. He underwent surgical closure of a ventricular septal defect at the age of 2 months, which occurred in the non-coronary sinus (NCS) and ruptured into the right atrium. We successfully occluded the ruptured sinus of Valsalva with a ventricular septal occluder.
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Affiliation(s)
- Xueyang Gong
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jundao Wang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Luyao Wei
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tianli Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shijun Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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18
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Arcario MJ, Lou S, Taylor P, Gregory SH. Sinus of Valsalva Aneurysms: A Review with Perioperative Considerations. J Cardiothorac Vasc Anesth 2020; 35:3340-3349. [PMID: 33431271 DOI: 10.1053/j.jvca.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Mark J Arcario
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Sunny Lou
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Phillip Taylor
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Stephen H Gregory
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO.
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19
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Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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20
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Towashiraporn K, Chaithiraphan V. Chronic Dissection of Left Sinus of Valsalva Obscuring Left Main Coronary Artery. J Invasive Cardiol 2019; 31:E233. [PMID: 31257223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Coronary angiography in a 44-year-old woman shows chronic dissection of the left sinus of Valsalva, totally obscuring the LMCA, with good collaterals supplying the left coronary system from the right coronary artery.
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Affiliation(s)
- Korakoth Towashiraporn
- Her Majesty Cardiac Center, Siriraj Hospital, 7th Floor, Bangkok Noi, Bangkok, Thailand, 10700.
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21
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Žumbakytė-Šermukšnienė R, Slapšinskaitė A, Baranauskaitė M, Borkytė J, Sederevičiūtė R, Berškienė K. Exploring the Aortic Root Diameter and Left Ventricle Size Among Lithuanian Athletes. ACTA ACUST UNITED AC 2019; 55:medicina55060271. [PMID: 31212719 PMCID: PMC6630885 DOI: 10.3390/medicina55060271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/28/2019] [Accepted: 06/05/2019] [Indexed: 01/25/2023]
Abstract
Background and objectives: Aortic rupture is known as one of the potential causes of sudden cardiac death in athletes. Nevertheless, adaptation strategies for aortic root dilation in athletes vary. The purpose of this study was to investigate aortic root adaptation to physical workload and to determine if aortic roots and left ventricle sizes are contingent upon the physical workload. Materials and Methods: Echocardiography was applied to 151 subjects to measure the aortic root at aortic valve annulus (AA) and at sinus of Valsalva (VS). 122 were athletes (41 females and 81 males) and 29 were non-athletes (14 females and 15 males). Of the 41 female athletes, 32 were endurance athletes, and 9 were strength athletes. From 81 male athletes, 56 were endurance athletes, and 25 were strength athletes. AA and VS mean values for the body surface area were presented as AA relative index with body surface area (rAA) and VS relative index with body surface area (rVS). Left ventricle (LV) measures included LV end-diastolic diameter (LVEDD), interventricular septum thickness in diastole (IVSTd), LV posterior wall thickness in diastole (LVPWTd), LV mass (LVM), LV mass index, and LV end-diastolic diameter index (LVEDDI). Results: Results indicated that VS was higher in female athletes (28.9 ± 2.36 mm) than in non-athletes (27.19 ± 2.87 mm, p = 0.03). On the other hand, rAA was higher in strength athletes (12.19 ± 1.48 mm/m2) than in endurance athletes (11.12 ± 0.99 mm/m2, p = 0.04). Additionally, rVS and rAA were higher in female strength athletes (17.19 ± 1.78 mm/m2, 12.19 ± 1.48 mm/m2) than female basketball players (15.49 ± 1.08 mm/m2, p = 0.03, 10.75 ± 1.06 mm/m2, p = 0.02). No significant differences regarding aortic root were found between male athletes and non-athletes. Statistically significant positive moderate correlations were found between VS and LVEDD, LVM, IVSTd, LVPWTd, rVS, and LVEDDI parameters in all athletes. Conclusion: The diameter of Valsalva sinus was greater in female athletes compared to non-athletes. The rAA mean value for body surface area was greater in female athletes practising strength sports as compared to their counterparts who were practising endurance sports. The diameter of the aortic root at sinuses positively correlated with the LV size in all athletes.
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Affiliation(s)
| | - Agnė Slapšinskaitė
- Sports Medicine Clinics, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
- Health Research Institute, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
| | - Miglė Baranauskaitė
- Sports Medicine Clinics, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
| | - Julija Borkytė
- Sports Medicine Clinics, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
| | - Rasa Sederevičiūtė
- Radiology Clinic, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
| | - Kristina Berškienė
- Sports Medicine Clinics, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
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22
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Uemura A, Tanaka R, Nakata TM, Namiki R, Tanaka T, Matsuura K, Yoshida T. Unruptured right sinus of Valsalva aneurysm in a Maltese dog: a case report. J Vet Sci 2019; 20:e20. [PMID: 31161738 PMCID: PMC6538510 DOI: 10.4142/jvs.2019.20.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/09/2019] [Accepted: 03/07/2019] [Indexed: 11/20/2022] Open
Abstract
A rare case of an unruptured sinus of Valsalva aneurysm (SVA) in a 2-month-old male Maltese terrier weighing 1.0 kg with a heart murmur is presented. A right SVA and a ventricular septal defect (VSD) were diagnosed by echocardiography and cardiac catheterization. The dog died due to a worsening of his condition. The necropsy revealed the sinus of Valsalva to have a diameter of 7 mm and a VSD hole was on the opposite surface. This report is the first to describe an unruptured SVA in the right coronary cusp of a small dog.
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Affiliation(s)
- Akiko Uemura
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan.
| | - Ryou Tanaka
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Telma Mary Nakata
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Ryousuke Namiki
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Takashi Tanaka
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Katsuhiro Matsuura
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Tomohiko Yoshida
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
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23
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Hang D, Miller RE, Rokkas CK, Pagel PS. Coronary Confusion? An Unexpected Congenital Anomaly in a Patient with an Ostium Secundum Atrial Septal Defect. J Cardiothorac Vasc Anesth 2019; 33:2600-2603. [PMID: 31072707 DOI: 10.1053/j.jvca.2019.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Dustin Hang
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Rebecca E Miller
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Chris K Rokkas
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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24
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Wingo M, de Angelis P, Worku BM, Leonard JR, Khan FM, Hameed I, Lau C, Gaudino M, Girardi LN. Sinus of Valsalva aneurysm repairs: Operative technique and lessons learned. J Card Surg 2019; 34:400-403. [PMID: 30953447 DOI: 10.1111/jocs.14041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/15/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Sinus of Valsalva (SOV) aneurysms are rare and data on operative management are limited. They can cause right ventricular outflow tract or pulmonary artery compression, and rupture may be fatal. In this study, we describe our experience with the repair of 13 SOV aneurysms. METHODS All patients who underwent SOV aneurysm repair from May 2001 to December 2017 at our single tertiary referral center were reviewed retrospectively. RESULTS Thirteen patients (92% male) with a mean age of 60 years underwent repair of an SOV aneurysm; mean aneurysm diameter was 5.9 ± 0.8 cm and four patients (30.7%) presented with rupture into another cardiac chamber. Operative interventions included six Bentall procedures, five patch repairs (one with aortic valve replacement [AVR]), and two primary aneurysm closures both with concomitant AVR. There were no strokes, myocardial infarctions, re-explorations, or deaths in the postoperative period. After an average of 2.25 years, computed tomographic imaging in five patients demonstrated no aneurysm recurrence. CONCLUSIONS Surgery is a safe option for both ruptured and nonruptured SOV aneurysms. A variety of repair strategies may be used. Larger studies are needed.
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Affiliation(s)
- Matthew Wingo
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Paolo de Angelis
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Berhane M Worku
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Jeremy R Leonard
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Faiza M Khan
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
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25
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Takahashi N, Nakada TA, Oda S. Delayed aortic regurgitation due to traumatic pseudoaneurysm of the sinus of Valsalva. Acute Med Surg 2019; 6:185-187. [PMID: 30976446 PMCID: PMC6442520 DOI: 10.1002/ams2.386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/21/2018] [Indexed: 01/29/2023] Open
Abstract
Case Pseudoaneurysm of the sinus of Valsalva (PSV) caused by trauma is rare. Surgical intervention is the standard treatment approach for traumatic PSV, as it has a high risk of rupture and is potentially fatal.We hereby report a 59‐year‐old man with traumatic PSV due to a traffic accident. Imaging studies revealed traumatic PSV. However, he refused surgery due to the lack of symptoms and was discharged on day 9. Two years later, he visited our hospital with cardiac failure due to severe aortic valve regurgitation (AR) induced by PSV. Outcome A Bentall operation was carried out and the patient was discharged without any complications. Conclusions This case illustrates progression to aortic valve regurgitation as a complication of traumatic PSV and stresses the point that surgical intervention should be considered even in asymptomatic cases of traumatic PSV. First computed tomography angiography image (Fig. 1.) and three‐dimensional reconstruction of multidetector computed tomography (Fig. 2.) of a 59‐year‐old man with traumatic pseudoaneurysm of the sinus of Valsalva due to a traffic accident revealed expansion of the sinus of Valsalva (diameter of 37.5 ms).
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Affiliation(s)
- Nozomi Takahashi
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Shigeto Oda
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
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26
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Amano T, Naganuma T, Nakamura S. Stabilized Sinus of Valsalva Aneurysm After CoreValve Implantation. JACC Cardiovasc Interv 2019; 12:103-5. [PMID: 30621966 DOI: 10.1016/j.jcin.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
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27
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Fakoya AOJ, Otohinoyi DA, Omole AE, Oladele C, Kalejaiye A, Onuegbu A, Nwalie E, Talukdar D, Erinkitola O. Correlating possible predisposing demographics and systemic conditions with the aortic root. Ann Afr Med 2018; 17:133-139. [PMID: 30185682 PMCID: PMC6126053 DOI: 10.4103/aam.aam_51_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The aortic root is an aggregate of various components that connects the left ventricle to the aorta. The most predominant pathologies have been associated with the dilation of the aortic root leading to aneurysms. Aim This study is designed to measure the role of systemic morbidities such as hypertension, diabetes, and body mass index (BMI) on the dimension of the aortic root. Materials and Methods Participants were volunteers of African descent who were recruited during and after an organized health fair by the medical students' body from All Saints University, School of Medicine. 169 participants consisting of 62 males and 107 females with ages ranging from 9 to 84 years agreed to volunteer by signing the consent after which a questionnaire was administered and a preliminary clinical procedure was used to check for blood pressure (BP), blood glucose (BG), and BMI. The measurement of the aortic root was carried out by an experienced single investigator who was not aware of the purpose of measurements, using a DUS-5000 ultrasound machine (Miami, Florida, USA) at a low-frequency micro-convex transducer preset to "adult cardiac" with a default frequency of 4 MHz. Results Among the participants, 35.03%, 47.80%, and 29.11% had normal BP, BG, and BMI readings, respectively. The Chi-squared analysis identified a significant correlation between the diameter of the aortic annulus (AA) and BMI. Diastolic BP is also correlated with the diameter of the AA. Sinus of Valsalva (SV) showed an unusual correlation with BG as opposed to BP and BMI. Conclusion The disparity in how a systemic factor individually correlates with the AA and the SV is not clear. The study targets to provide educational concept in this regard.
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Affiliation(s)
- Adegbenro Omotuyi John Fakoya
- Department of Anatomical Sciences, University of Medicine and Health Sciences, St. Kitts and Nevis, Roseau, Dominica
- Department of Anatomical Sciences, School of Medicine, All Saints University, Roseau, Dominica
| | | | - Adekunle Ebenezer Omole
- Department of Basic Medical Sciences, American University of Antigua, College of Medicine, St. John's, Antigua
| | - Charles Oladele
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Ayoola Kalejaiye
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Angel Onuegbu
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Esther Nwalie
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
| | - Debjyoti Talukdar
- Medical Student, School of Medicine, All Saints University, Roseau, Dominica
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28
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Malakan Rad E, Pouraliakbar H. Congenital unruptured aneurysm of sinus of Valsalva, quadricuspid aortic valve, and ascending aortic aneurysm associated with genetic leukoencephalopathy in an infant: A new syndrome? Echocardiography 2017; 34:1959-1964. [PMID: 28994146 DOI: 10.1111/echo.13723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report a 15-month-old female with unruptured noncoronary sinus of Valsalva anreurysm (SOVA) associated with quadricuspid aortic valve, ascending aortic aneurysm (AAA), moderate aortic insufficiency, mild mitral insufficiency, genetic leukoencepaholpathy, developmental delay and mild mixed aminoaciduria. She was referred for evaluation of a cardiac murmur. Initial echocardiographic examination showed the aneurysm as a round cyst in the right atrium which changed in size during systole and diastole. As to the best of our knowledge, this is the first report of association of SOVA, quadricuspid aortic valve, AAA and genetic leukoencephalopathy in an infant. These associations may suggest a new syndrome. We describe the echocardiographic and computed tomographic angiography findings. We also review 641 cases in the literature and the current six classification systems for SOVA.
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Affiliation(s)
- Elaheh Malakan Rad
- Pediatric Cardiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pouraliakbar
- Rajaee Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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29
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Luo Y, Fang Z, Meng W. A giant aneurysm of noncoronary sinus of Valsalva concomitant with aortic regurgitation and mitral regurgitation. Echocardiography 2017; 34:796-798. [PMID: 28295517 DOI: 10.1111/echo.13503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aneurysms of the sinus of Valsalva (ASV) are rare, with an incidence ranging from 0.1% to 3.5% of all congenital cardiac defects and a prevalence of 0.009% in an autopsy series.ASVs occur much more frequently in the right coronary sinus of Valsalva. Previous reports, based on necropsy and cardiac surgery findings, estimated that 20% of ASVs are unruptured. Patients with an unruptured ASV may remain asymptomatic for a long period of time until rupture. They may also presented with dyspnea, palpitation, and angina-like chest pain. Aortic insufficiency in the patients with unruptured ASVs is common, and other valvular lesions can be observed in these patients as well. Echocardiography, as a noninvasive and portable tool, is widely used to detect ASVs. Additionally, computed tomography and cardiac magnetic resonance imaging, alone or in combination, can provide precise information about its anatomic extension and intrinsic characteristics of the pathology.
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Affiliation(s)
- Yi Luo
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Zhi Fang
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Meng
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
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30
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Guner A, Celik M, Kahyaoglu M, Candan O, Havan N, Ak A, Karaman O, Hakgor A, Onal C, Gecmen C. Multiple aneurysmatic involvement of sinus of Valsalva. Echocardiography 2017; 34:627-628. [PMID: 28266724 DOI: 10.1111/echo.13478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/17/2017] [Indexed: 11/30/2022] Open
Abstract
Forty-five-year-old male patient presented with chest pain and dyspnea lasting for three weeks. Transthoracic echocardiography demonstrated a huge right sinus of Valsalva aneurysm. Contrast-enhanced cardiac computed tomography was performed and revealed three large unruptured sinus of Valsalva aneurysms.
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Affiliation(s)
- Ahmet Guner
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Mehmet Celik
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Muzaffer Kahyaoglu
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ozkan Candan
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Nuri Havan
- Department of Radiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Adnan Ak
- Department of Cardiac Surgery, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ozge Karaman
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Aykun Hakgor
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Cagatay Onal
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Cetin Gecmen
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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31
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Hoda M, Verma A, Alapati S, Alapati S, Yarrabolu TR. Diagnostic paradox: Ruptured aneurysm of sinus of Valsalva simulating tricuspid valve endocarditis. Echocardiography 2017; 34:465-467. [PMID: 28213924 DOI: 10.1111/echo.13479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Rupture of aneurysm of sinus of Valsalva into the right atrium mimicking tricuspid valve endocarditis is a rare presentation. We review a case of spontaneous rupture of aneurysm of sinus of Valsalva into the right atrium presenting as a murmur. Transthoracic echocardiogram showed a mobile mass that appeared to be attached to the tricuspid valve leaflet with moderate tricuspid regurgitation suggestive of tricuspid valve endocarditis. The diagnosis was confirmed as spontaneous rupture of noncoronary sinus in to the right atrium by transesophageal echocardiogram. Patient recovered completely after surgical repair.
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Affiliation(s)
- Mehar Hoda
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX, USA
| | - Arushi Verma
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX, USA
| | - Sridevi Alapati
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX, USA
| | - Srilatha Alapati
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX, USA
| | - Tharakanatha R Yarrabolu
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, TX, USA.,Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA
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32
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Chigurupati K, Kumaresan B, Gadhinglajkar S, Sreedhar R. Multiple unruptured aortic sinus of Valsalva aneurysms: A rare presentation. Echocardiography 2017; 34:317-319. [PMID: 28130885 DOI: 10.1111/echo.13423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/29/2016] [Accepted: 11/17/2016] [Indexed: 11/30/2022] Open
Abstract
Aneurysms of sinus of Valsalva, usually a rare presentation, account for 0.1%-3.5% of congenital heart defects. They rarely present unless rupture occurs. There are very few cases of unruptured sinus of Valsalva aneurysms that presented with myocardial ischemia, symptomatic cardiac dysfunction, and conduction abnormalities. We present a case of multiple unruptured sinus of Valsalva aneurysms with particular emphasis on the transesophageal echocardiography.
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Affiliation(s)
- Keerthi Chigurupati
- Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Balaji Kumaresan
- Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Shrinivas Gadhinglajkar
- Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Rupa Sreedhar
- Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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33
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Gilbert J, Sheppard MN, Byard RW. Sudden Infant and Early Childhood Death and Sinus of Valsalva Pseudoaneurysms. J Forensic Sci 2016; 62:531-535. [PMID: 27864952 DOI: 10.1111/1556-4029.13293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/14/2016] [Accepted: 06/26/2016] [Indexed: 11/27/2022]
Abstract
Two cases of occult pseudoaneurysms of the sinus of Valsalva (SoV) are reported to demonstrate different etiologies and lethal mechanisms. A previously well 9-month-old boy who suffered an unexpected fatal cardiorespiratory arrest was found at autopsy to have a ruptured pseudoaneurysm of the left SoV resulting in lethal hemopericardium. A 13.5-month-old boy died soon after presenting with a 24-h history of poor feeding and reduced urine output. At autopsy, destruction of the noncoronary cusp of the aortic valve by bacterial endocarditis was found with extension of the inflammation into a pseudoaneurysm of the SoV with surrounding abscess formation involving the atrioventricular node. Death was most likely due to an arrhythmia. Pseudoaneurysms of the SoV are exceedingly rare but may result in sudden/unexpected death in infancy and early childhood from rupture or involvement of the conduction system or myocardium. Detailed cardiac examination is essential in all unexpected deaths in early life.
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Affiliation(s)
- John Gilbert
- Forensic Science SA, 21 Divett Place, Adelaide, 5000, Australia
| | - Mary N Sheppard
- Cardiovascular Pathology Unit, St Georges Medical School, London, SW170RE, UK
| | - Roger W Byard
- Forensic Science SA, 21 Divett Place, Adelaide, 5000, Australia.,School of Medicine, The University of Adelaide, Frome Rd, Adelaide, 5005, Australia
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34
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Abstract
An 81-year-old male with end-stage renal disease undergoing hemodialysis was admitted to our hospital for congestive heart failure secondary to severe aortic stenosis. Transesophageal echocardiography revealed a 15.3 × 9.9 mm calcified mass in the sinus of Valsalva. The tumor was diagnosed as a calcified amorphous tumor (CAT) by histologic examination. This is the first report of a CAT that originated in the sinus of Valsalva.
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Affiliation(s)
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Tatsuya Nakao
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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35
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Abstract
Pseudoaneurysm is an uncommon sequela of infective endocarditis. We treated a 44-year-old man who had an active case of group B streptococcal infective endocarditis of the aortic valve despite no evidence of valvular dysfunction or vegetation on his initial transesophageal echocardiogram. After completing 6 weeks of intravenous antibiotic therapy, the patient developed a sinus of Valsalva pseudoaneurysm and severe aortic regurgitation caused by partial detachment of the left coronary cusp. We used a pericardial patch to close the pseudoaneurysm and repair the coronary cusp. This case shows the importance of routine clinical follow-up evaluation in infective endocarditis, even after completion of antibiotic therapy. Late sequelae associated with infective endocarditis or its therapy include recurrent infection, heart failure caused by valvular dysfunction (albeit delayed), and antibiotic toxicity such as aminoglycoside-induced nephropathy and vestibular toxicity.
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36
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Affiliation(s)
- Rabia Amir
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Lu Yeh
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Department of Anesthesia and Pain Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
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37
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Olędzki S, Czechowska M, Chlasta J, Gorący J. Retrograde dissection of the ascending aorta during diagnostic coronary angiography in a patient who previously had resection of the aortic adventitia tumor and coronary bypass grafting. Pol Merkur Lekarski 2016; 40:186-189. [PMID: 27088202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Retrograde dissection of ascending aorta is a very rare but life threating complication of coronary catheterization. Despite the seriousness of the complication, there is little data on the subject. Majority of case reports in literature includes patients without comorbidities that may affect the management. We experienced the retrograde dissection of the ascending aorta in a patient who previously had resection of the tumor originating from aortic root and coronary bypass grafting. No similar case has been reported in literature. The data from literature does not include the patients with comorbidities like previous coronary bypass grafting. For that reason we had hesitation in decision making. Wherefore, the aim of this article is to share our experience in this matter.
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Affiliation(s)
- Szymon Olędzki
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | | | - Jacek Chlasta
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Jarosław Gorący
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
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38
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Hu YN, Tsai WC, Tsai YS, Luo CY. Misdiagnosis in Hypoplastic Sinus of Valsalva with Localized Aneurysm: A Diagnostic Pitfall in Computed Tomography. Echocardiography 2016; 33:947-9. [PMID: 26818095 DOI: 10.1111/echo.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yu-Ning Hu
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital Dou-Liou Branch, Yunlin, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chuan Tsai
- Division of Cardiology, Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Shan Tsai
- Department of Radiology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chwan-Yau Luo
- Division of Cardiovascular Surgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Cardiovascular Research Center, National Cheng Kung University, Tainan, Taiwan
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39
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Boettcher BT, Irish SM, Algahim M, Rokkas CK, Plambeck CJ, Novalija J, Pagel PS. Acute, Severe Chest Pain in the Presence of Known Coronary Artery Disease: New Myocardial Ischemia, Aortic Dissection, or Some Other Evolving Cardiovascular Catastrophe? J Cardiothorac Vasc Anesth 2015; 30:841-4. [PMID: 26619952 DOI: 10.1053/j.jvca.2015.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Mohamed Algahim
- Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Chris K Rokkas
- Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jutta Novalija
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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40
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Labsaili H, Leprince P. Ruptured sinus of Valsalva aneurysm developed forty years after aortic valve replacement by Starr-Edwards mechanical valve. Pan Afr Med J 2015; 20:80. [PMID: 26090038 PMCID: PMC4450039 DOI: 10.11604/pamj.2015.20.80.5983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 01/26/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hicham Labsaili
- Assistance Publique-Hôpitaux de Paris, Department of Cardiac and Thoracic Surgery, Institute of cardiology, La Pitié-Salpêtrière hospital, Paris, France
| | - Pascal Leprince
- Assistance Publique-Hôpitaux de Paris, Department of Cardiac and Thoracic Surgery, Institute of cardiology, La Pitié-Salpêtrière hospital, Paris, France
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41
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Divakar SR, Singh C, Verma CM, Kulkarni CD. Cesarean section under epidural anesthesia in a documented case of ruptured aneurysm of the sinus of valsalva. J Anaesthesiol Clin Pharmacol 2015; 31:119-22. [PMID: 25788785 PMCID: PMC4353136 DOI: 10.4103/0970-9185.150565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Ruptured aneurysm of sinus of Valsalva (RSOV) occurring in pregnancy is a rare cardiac anomaly and it may be either congenital or acquired. Congenital sinus of Valsalva aneurysms are commonly associated with other structural defects such as ventricular septal defect (50-55%), aortic regurgitation (AR) (25-35%), bicuspid aortic valve (10-15%) and Marfan's syndrome (10%). RSOV in pregnancy accentuates the hemodynamic stress on maternal cardiovascular system and pose a significant challenge from obstetric anesthesia point of view. We report a case of 35-year-old documented patient of RSOV with mild AR presenting completely asymptomatic at 37 weeks 4 days of gestation. A successful elective lower segment cesarean section was conducted under epidural anesthesia.
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Affiliation(s)
- S R Divakar
- Department of Anesthesiology and Critical Care, GSVM Medical College and LLR Hospitals, Kanpur, Uttar Pradesh, India
| | - Chandrashekhar Singh
- Department of Anesthesiology and Critical Care, GSVM Medical College and LLR Hospitals, Kanpur, Uttar Pradesh, India
| | - Chandra Mohan Verma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College and LLR Hospitals, Kanpur, Uttar Pradesh, India
| | - Chaitanya D Kulkarni
- Department of Radiology, GSVM Medical College and LLR Hospitals, Kanpur, Uttar Pradesh, India
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42
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Abstract
We describe a new technique of prosthesis-preserving aortic root replacement for patients who have previously undergone aortic valve replacement. With preservation of the mechanical prosthesis, we implant a Gelweave Valsalva graft using double suture lines. The first suture line is made between the sewing cuff of the mechanical valve and the graft, with mattress sutures of 2/0 braided polyester with pledgets. After the first sutures are tied, the second suture line is created between the graft collar and the aortic root remnant with continuous 4/0 polypropylene sutures.
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Affiliation(s)
- Masaki Hamamoto
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Taira Kobayashi
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Hiroshi Kodama
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
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Kato T, Tomita S, Tamaki M, Okawa Y. Aneurysm of the sinus of Valsalva dissecting into the intraventricular septum. Asian Cardiovasc Thorac Ann 2014; 24:172-4. [PMID: 25178471 DOI: 10.1177/0218492314549585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aneurysm of the sinus of Valsalva is an uncommon entity and especially rare when it dissects into the intraventricular septum. This uncommon clinical manifestation often takes a drastic clinical course with life-threatening arrhythmia, coronary ischemia, rupture, and heart failure. We present the case of a 36-year-old man with an aneurysm of the sinus of Valsalva dissecting into the intraventricular septum, which induced severe aortic insufficiency and heart block.
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Affiliation(s)
- Takayoshi Kato
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Shinji Tomita
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
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Abstract
Single coronary artery (SCA) is a very rare finding. Although most cases of SCA are found incidentally on coronary angiography, it can potentially lead to different clinical repercussions.1, 2 Herein we describe a patient with SCA who had unstable angina with subsequent sudden cardiac arrest, and we provide a brief review of the recent literature.
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Affiliation(s)
| | | | | | - Su Min Chang
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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Abstract
Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that can be congenital or acquired. We report 2 cases of SVA. The first case involves a 59-year-old male presenting with frequent syncope. Echocardiogram revealed a large right SVA obstructing the right ventricular outflow tract (RVOT). The second case involves a 21-year-old female presenting with sudden onset chest pain and a continuous machinery murmur. Echocardiogram revealed a ruptured right SVA into the right atrium. Although advanced percutaneous techniques have been implemented in the correction of this anomaly, open-heart surgery with or without aortic valve replacement remains the treatment of choice.
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Affiliation(s)
- Nishit Patel
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Abstract
A 48-year-old woman underwent aneurysmectomy and primary suture repair with a pericardial patch for sinus of Valsalva aneurysm secondary to ankylosing spondylitis. The sinus of Valsalva aneurysm recurred one year after surgery, and reached a diameter of 53 mm. Special attention must be paid to the potential relapse of aortic aneurysms that develop secondary to autoimmune disorders, when using primary suture or patch repair.
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Affiliation(s)
- Suleyman Ercan
- Department of Cardiology, Gaziantep University, Gaziantep, Turkey
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47
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Yoo SJ, Shin DH, Kim EJ, Lee JH, Oh KH, Choi KU. Cardiac arrest during exercise; rupture of the sinus of Valsalva with dissection into the interventricular septum. Echocardiography 2013; 31:E64-5. [PMID: 24147750 DOI: 10.1111/echo.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Seung Jin Yoo
- Department of Internal Medicine, Division of Cardiology, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
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48
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Ribeiro HB, Webb JG, Makkar RR, Cohen MG, Kapadia SR, Kodali S, Tamburino C, Barbanti M, Chakravarty T, Jilaihawi H, Paradis JM, de Brito FS, Cánovas SJ, Cheema AN, de Jaegere PP, del Valle R, Chiam PTL, Moreno R, Pradas G, Ruel M, Salgado-Fernández J, Sarmento-Leite R, Toeg HD, Velianou JL, Zajarias A, Babaliaros V, Cura F, Dager AE, Manoharan G, Lerakis S, Pichard AD, Radhakrishnan S, Perin MA, Dumont E, Larose E, Pasian SG, Nombela-Franco L, Urena M, Tuzcu EM, Leon MB, Amat-Santos IJ, Leipsic J, Rodés-Cabau J. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol 2013; 62:1552-62. [PMID: 23954337 DOI: 10.1016/j.jacc.2013.07.040] [Citation(s) in RCA: 409] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/15/2013] [Accepted: 07/23/2013] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This study sought to evaluate the main baseline and procedural characteristics, management, and clinical outcomes of patients from a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) who suffered coronary obstruction (CO). BACKGROUND Very little data exist on CO following TAVI. METHODS This multicenter registry included 44 patients who suffered symptomatic CO following TAVI of 6,688 patients (0.66%). Pre-TAVI computed tomography data was available in 28 CO patients and in a control group of 345 patients (comparisons were performed including all patients and a cohort matched 1:1 by age, sex, previous coronary artery bypass graft, transcatheter valve type, and size). RESULTS Baseline and procedural variables associated with CO were older age (p < 0.001), female sex (p < 0.001), no previous coronary artery bypass graft (p = 0.043), the use of a balloon-expandable valve (p = 0.023), and previous surgical aortic bioprosthesis (p = 0.045). The left coronary artery was the most commonly involved (88.6%). The mean left coronary artery ostia height and sinus of Valsalva diameters were lower in patients with obstruction than in control subjects (10.6 ± 2.1 mm vs. 13.4 ± 2.1 mm, p < 0.001; 28.1 ± 3.8 mm vs. 31.9 ± 4.1 mm, p < 0.001). Differences between groups remained significant after the case-matched analysis (p < 0.001 for coronary height; p = 0.01 for sinus of Valsalva diameter). Most patients presented with persistent severe hypotension (68.2%) and electrocardiographic changes (56.8%). Percutaneous coronary intervention was attempted in 75% of the cases and was successful in 81.8%. Thirty-day mortality was 40.9%. After a median follow-up of 12 (2 to 18) months, the cumulative mortality rate was 45.5%, and there were no cases of stent thrombosis or reintervention. CONCLUSIONS Symptomatic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication.
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Affiliation(s)
- Henrique B Ribeiro
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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Rosenthal RL, Carrothers IA, Schussler JM. Benign or malignant anomaly? Very high takeoff of the left main coronary artery above the left coronary sinus. Tex Heart Inst J 2012; 39:538-541. [PMID: 22949773 PMCID: PMC3423280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Very high takeoff of the left main coronary artery in the absence of another coronary anomaly is a rare finding. The pathologic consequences of this anomaly are unclear, and the literature on this subject does not agree on whether the condition is dangerous. We present our findings in 2 patients who were discovered to have this anomaly upon noninvasive computed tomographic coronary angiography, and we discuss our analysis of the literature and our management of these patients.
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Affiliation(s)
- Robert L Rosenthal
- Division of Cardiology, Baylor University Medical Center and Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas 75226, USA
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50
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Abstract
This is a retrospective, observational study comprising of eight patients with isolated rupture of the sinus of Valsalva (RSOV) who underwent transcatheter device closure. The mean age of presentation was 32.8 ± 10.0 years. New York Heart Association (NYHA) class at the time of presentation was II (six patients) and III (two patients). The RSOVs were all closed using a patent ductus arteriosus device. The mean procedural time was 42.3 ± 5.4 minutes, while the fluoroscopic time was 24.5 ± 6.9 minutes. All had complete closure of the shunt. The average hospital stay was 2.9 ± 1.1 days. There were no major complications. The patients were followed up for a mean of 11.3 ± 4.1 months. At the time of the last follow up all the patients were in NYHA class I. We conclude that in the short term, transcatheter closure of isolated RSOV is a viable alternative to surgical repair.
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Affiliation(s)
- Supratim Sen
- Department of Pediatric Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
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