This patients diagnosis was made by recognizing abnormal oxygen saturations during a right heart catheterization shunt run and followup transthoracic echocardiogram using color. Ruptured sinus of valsalva rsov is a relatively uncommon cause of acute haemodynamic worsening which is usually seen in youngaged or middleaged individuals. Ruptured sva can be associated with various congenital heart defects. Mayer ed, ruffmann k, saggau w, butzmann b, bernhardtmayer k, schatton n. Ruptured sinus of valsalva aneurysm cath lab digest. Transesophageal echocardiography tee confirmed a rupture of sinus of valsalva aneurysm and ventricular septal defect. Transcatheter closure of ruptured sinus of valsalva. Degeneration of the aortic valve is by far the most common reason for ar, although other potential causes include idiopathic prolapse, bacterial endocarditis, congenital valvular disease, vsd see the previous discussion in this chapter, noninfective valvulitis, and ruptured aortic sinus aneurysm see tables 82 and 83. Surgery has good reputation having a 2 transcatheter closure tcc of ruptured sinus of valsalva aneurysm rsova appears to be a reasonable alternative.
The subject was a 35yearold male who complained to a coworker of shortness of. Repair was achieved through an incision in the cardiac chamber of the fistula exit in 61 patients. Sinus of valsalva aneurysm medication medscape reference. Sinus of valsalva aneurysm sva is a rare cardiac anomaly which has potential for spontaneous rupture into other cardiac chambers or the pericardial space depending on its location. Repair of a sinus of valsalva aneurysm that had ruptured. Several approaches for repair, through the aortic root or the chamber into which the aneurysm ruptures or a combination of both, have been described. Ruptured sinus of valsalva aneurysm rsva is relatively common in oriental patients. A ruptured sinus of valsalva is a rare cardiac anomaly. Transthoracic color doppler echocardiography revealed ruptured non coronary sinus of valsalva to right ventricle with large left to right shunt, perimembraneous sub. The conventional treatment of rsva is surgical repair under cardiopulmonary bypass cpb or percutaneous catheter closure.
An electrocardiogram showed firstdegree atrioventricular block, while the his bundle electrogram demonstrated the. Severe aortic regurgitation after repair of ruptured sinus. Abstracta young adult who presented with congestive heart failure was found to have. Realtime threedimensional transesophageal echocardiography. Sinus of valsalva aneurysm medigoo health medical tests. The relation between the rupture, right atrium ra, and aortic valve ao can be clearly seen b, online videos 2 and 3. Ruptured sinus of valsalva aneurysm from the left coronary sinus communicating through the mitral. Minimal tricuspid regurgitation and minimal mitral regurgitation. Ruptured aneurysm of the noncoronary sinus of valsalva. Herein, we report the operative correction of thirtyone patients of ruptured aneurysms of the sinus of valsalva, using the on. Sva are asymptomatic unless they compress adjacent structures, form a thrombus, or rupture causing left to right shunting or aortic valve.
Nov 30, 2016 this video is about rsov patient who remained undiagnosed until dr a. A case of sinus of valsalva aneurysm rupture in a patient with bicuspid aortic valve. Few large or longterm series exist regarding the management of patients with sinus of valsalva aneurysms or fistulas svafs. Transthoracic minimally invasive closure for the treatment. Jeyamalar summary over a period ofnine years, from june 1976 through may 1985, 18 cases ofruptured sinus of. Surgical treatment of a giant unruptured aneurysm of the. Ruptured sinus of valsalva rsov is a relatively uncommon. The patient underwent elective surgical repair of the ruptured sinus and intraoperative tee demonstrated severe aortic regurgitation after repair and mechanical prosthetic valve was implanted.
We are not aware of any other ruptured sva case associated with doublechambered right ventri. Rare case of ruptured sinus of valsalva aneurysm presenting only with diastolic. Echocardiogram and computed tomography angiography cta of the chest revealed marked dilatation of the left sinus of valsalva, measuring 7. Sinus of valsalva anuerysm with flow into the right ventricular outflow tract. Aneurysm of sinus of valsalva is a rare anomaly which arises from a congenital defect of the aortic media or due to damage caused by bacterial endocarditis. Three dimensional midsophageal aortic valve short axis view video showing the. Sinus of valsalva aneurysm and fistula springerlink. With corrective surgery, there is a 94% survival rate at 10 years. Aortic regurgitation ar is a common valvular insufficiency. Unusual presentation and rupture of left sinus of valsalva. Transcatheter closure of ruptured sinus of valsalva aneurysm using. A ruptured sva has a very poor prognosis with high morbidity and mortality.
We report a case of a 21yearold male who suffered an aneurysm of the sinus of valsalva rupture into the. Here, we present one case of rsva undergo transthoracic. Congestive heart failure is known to be the main cause of death. Acute rupture of a sinus of valsalva aneurysm into the right. Here, we present one case of rsva undergo transthoracic minimally invasive closure, which is a novel. Transthoracic echocardiographic imaging of a ruptured sinus of valsalva aneurysm.
Rupture of aneurysms of the sinus of valsalva results in abrupt onset of congestive heart failure. We present a case of a 23yearold man who presented with a 20day history of symptoms of worsening breathlessness. This article is from journal of cardiovascular disease research, volume 3. Severe pulmonary hypertension pasp at least 70 mm hg. Furthermore, a giant aneurysm of the sinus of valsalva of the noncoronary aortic cusp was seen with rupture to the enlarged left atrium figure 1. Surgery was suggested even tough the patient was asymptomatic. We present the case of a 68yearold woman with a giant aneurysm of the sinus of valsalva of the noncoronary aortic cusp leading to heart failure, diagnosed with transthoracic echocardiography.
These two echocardiographic findings should alert the clinician to a diagnosis of a ruptured sinus of valsalva aneurysm. Sinus of valsalva aneurysm sva is a rare congenital heart malformation of one or more of the aortic sinuses, consisting of a dilation that when unruptured is usually asymptomatic but when ruptured presents with progressive exertional dyspnea, fatigue, chest pain and that can lead to congestive heart failure if left untreated. A case of sinus of valsalva aneurysm rupture in a patient with. Video 1 parasternal short axis view showing the classical windsock. A congenital thinwalled out pouching with an entirely intracardiac course, usually in the right or noncoronary sinus, that may rupture into the right, or rarely, the left heart chambers to form an aortocardiac fistula. Aortotomy was used in three patients and both routes were used in three patients. The relation between the rupture, right atrium ra, and aortic valve ao can be clearly seen b. Rupture of a giant aneurysm of the sinus of valsalva leading. Even though coarctation of the aorta can be associated with shunts lesions such as patent ductus arteriosus and ventricular septal defects, it has rarely being reported to be associated with. We report an unusual case of ruptured sinus of valsalva aneurysm associated with endocarditis that was caused by streptococcus pneumoniae serotype 21. Classical windsock deformity of ruptured sinus of valsalva. In this paper, we present a case of rupture of an aneurysm of the sinus of valsalva in which atrioventricular block developed, presumably due to. The main associated symptoms are conduction disturbances, myocardial ischemia, and syncopes. Ruptured sinus of valsalva aneurysm rsva is traditionally repaired by surgery but more recently.
Aneurysm of sinus of valsalva genetic and rare diseases. Ruptured sinus of valsalva how is ruptured sinus of. A ruptured sinus of valsalva aneurysm results in a communication between the aortic sinus and the atrium or right ventricle. Transthoracic minimally invasive closure for the treatment of. Aneurysm of sinus of valsalva is a rare congenital heart malformation of one or more of the aortic sinuses, consisting of a dilation that when unruptured is usually asymptomatic but when ruptured presents with progressive exertional dyspnea, fatigue, chest pain and that can lead to congestive heart failure if left untreated. Of 105 cases of lesions of the sinus of valsalva found over a 25year period at the shanghai chest hospital, 90 were ruptured sinuses or sinus aneurysms and 15 were unruptured aneurysms. Aneurysms may affect the right 6585%, noncoronary 1030%, or. A sinus of valsalva aneurysm sva is a rare cardiac anomaly, usually congenital in origin, rarely acquired, most often arising from right coronary sinus 80. We retrospectively analyzed 67 patients receiving repair of rsva in a beijing hospital over 5 years. It is more prevalent in men and people of asian descent. Thus far, less than 500 cases of aneurysmal rupture of the sinus of valsalva have been reported in the literature,1 despite being first reported by hope in 1839. Ruptured sinus of valsalva aneurysm is a rare cardiac anomaly.
Recording made with a thinklabs one digital stethoscope. Onpump beatingheart surgery may reduce cardiac impairment by maintaining coronary blood flow and avoiding cardioplegia. Both the aortic valve and the sinus of valsalva were successfully repaired. A rupture of a sinus of valsalva is a rare cardiac anomaly, mostly occuring in aneurysmal dilated sinuses. Colour doppler flow showed a continuous shunt figure 2, supplementary material online, video s1 between the aneurysm and left atrium with a gradient of 70 mmhg supplementary material online. Ascending aortic pressure was 10549 mm hg and an aortogram confirmed a sinus of valsalva rupture into the right atrium see panel. Aug 31, 2011 after repair, patients lifeexpectancy approximates that of the healthy population. Generally have an intracardiac course may protrude into the pericardial space and they may rupture into. Aortic root injection revealed rupture sinus of valsalva to the right ventricle, video 39. An aortic valve leaflet was perforated, likely by a bullet fragment. We have seen a case of rupture of an aneurysm of the noncoronary sinus into the right atrium. However, sova with aortic root abscess has rarely been reported. The patient was successfully operated with resection of the aneurysm and reconstruction of the sinus with xenopericard and recovered completely.
Ruptured sinus of valsalva in an asymptomatic patient a case report. Sinus of valsalva synonyms, sinus of valsalva pronunciation, sinus of valsalva translation, english dictionary definition of sinus of valsalva. Ruptured aneurysm of aortic sinus of valsalva into right. Ruptured sinus of valsalva aneurysm rsva can be associated with ventricular septal defects or isolated lesions. Clinical manifestations can vary from an incidental finding on an imaging study to a lifethreatening emergency. The abnormality is often congenital, but may also be acquired from endocarditis or trauma. The right sinus of valsalva is the most common site of aortic sinus aneurysmal dilatation, followed by the noncoronary sinus.
Rupture of sinus of valsalva with endocarditis and aortic. The patient with this unusual diagnosis and presentation was managed successfully. A ruptured sov aneurysm presents a clinical emergency and can lead to progressively deteriorating heart failure. Percutaneous closure of a ruptured sinus of valsalva aneurysm using the amplatzer duct occluder. Surgical correction of ruptured aneurysms of the sinus of. The sinus of valsalva was repaired with either a patch n 63 or direct sutures n 4. A ruptured sinus of valsalva aneurysm is a very rare cardiac anomaly. Surgical treatment of aneurysm of the sinus of valsalva. We report a case of a 51yearold female with a large symptomatic left sova. Jun 23, 2016 sinus of valsalva anuerysm with flow into the right ventricular outflow tract.
Presentation varies from asymptomatic findings to acute heart failure, which can rapidly worsen to cause death. The defect is adjacent to the aortic valve and may be associated with a leak in the valve. The diagnosis of ruptured sinus of valsalva aneurysm should be suspected in patients presenting with acute haemodynamic compromise and cardiac murmurs. Ruptured sinus of the valsalva aneurysm rsva is a rare cardiac anomaly. Most commonly it is associated with bicuspid aortic valves and to a lesser degree to other aortic abnormalities such as aortic root dilatation and aneurysms of the. Surgery revealed an aneurysmal mass the size of the tip of an index finger extending through the interatrial septum down to just above the tricuspid valvular ostium. Emergency surgery for ruptured sinus of valsalva aneurysms. Surgical findings included a large fistulous tract between the noncoronary sinus of valsalva and the ra measuring approximately 9 mm in diameter. The delivery cardiac chamber of a right aortic sinus fistula is typically the. Rupture of an aneurysm of the sinus of valsalva, with consequent abrupt hemodynamic changes, entails a heavy cardiac load and progressive cardiac failure. Nearly 80% of patients will have symptom when rsva ruptures into one of the cardiac chambers. Ruptured sinus valsalva aneurysm how is ruptured sinus. Transcatheter closure of ruptured sinus of valsalva aneurysm in a.
It may be congenital or acquired in origin and may rupture into any of the cardiac chambers, usually the rightsided ones, to form an aorticocardiac fistula. Jul 15, 2014 the role of threedimensional echocardiography in diagnosis and management of ruptured sinus of valsalva aneurysm. The patient was taken to the intensive care unit for haemofiltration before transfer for emergency repair of the ruptured sinus the same day. Sinus of valsalva definition of sinus of valsalva by the. The surgical repair of ruptured sinus of valsalva aneurysms. Sinus of valsalva aneurysm sova is a rare clinical entity. Successful device closure of a ruptured sinus of valsalva. Transcatheter closure of ruptured sinus valsalva aneurysm with retrograde approach 301 nus ruptured to the right ventricle dissecting the fibrous tissue in the atrioventricular sulcus. Ruptured congenital aneurysm of the sinus of valsalva with persistent left superior vena cava imaged by intraoperative transesophageal echocardiography. Color doppler imaging showed marked turbulent flow from the aortic aneurysm into the rv. A ruptured aneurysm typically leads to an aortocardiac shunt and progressively worsening heart failure. Ruptured aneurysms of the sinuses of valsalva may contribute to cardiac chambers overload and the jet from the apex of a perforation may predispose to infective endocarditis 3. Acute rupture of a sinus of valsalva aneurysm into the. Transthoracic echocardiography revealed a ruptured sinus of valsalva sov, which was confirmed on transesophageal echocardiography tee a, online video 1.
Video sequence the video sequence is available to view here. Rupture of a giant aneurysm of the sinus of valsalva. We report a case of a 21yearold male who suffered an aneurysm of. The development of a shunt between the sinus of valsalva and rightsided cardiac chambers results in a continuous. The aorta normally has three small pouches that sit directly above the aortic valve the sinuses of valsalva, and an aneurysm of one of these sinuses is a thinwalled swelling. Ruptured sinus of valsalva aneurysm sova is a rare but. Fluttering of the right side of the interventricular septum noted on mmode echocardiography in association with a bulging of the right sinus of valsalva detected by twodimensional echocardiography were present in a patient.
Cardiac tamponade may occur if the rupture involves the pericardial space. Severe aortic regurgitation after repair of ruptured sinus of. Aneurysm of the sinus of valsalva is an uncommon cardiac abnormality. An asymptomatic 23yearold man was noted to have a harsh pansystolic murmur on examination. Rare case of ruptured sinus of valsalva aneurysm presenting only. In our patient, there was ruptured sinus of valsalva aneurysm and a small aortic root abscess with small multiple vegetations 23 mm in size. The ruptured sinus of valsalva aneurysm was repaired. The transthoracic echocardiogram showed noncoronary sinus of valsalva. Sinus of valsalva aneurysm description, causes and risk factors. Tee figure 3, video 3 and video 3 color revealed an aneurysm of the right sinus of valsalva that had ruptured into the rv and subarterial vsd, with lefttoright shunting. A congenital lack of continuity in the media, between the aorta and annulus fibrosus of the aortic valve, may initiate aneurysm formation or, less frequently, infection or degeneration. The development of a shunt between the sinus of valsalva and rightsided cardiac chambers results in a continuous murmur on examination. Definitive diagnosis often requires cardiac catheterisation and unless endocarditis is suspected, an aortogram should be performed. Advance articles editors choice podcasts cardio image bank cme ehj today videos open access articles.
Sinus of valsalva aneurysm sva occurs infrequently, with an incidence of 0. Echocardiographic diagnosis of ruptured right sinus of valsalva. We are happy to report that this patient made a full recovery from his sinus of valsalva aneurysm rupture. Echocardiogram and computed tomography angiography cta of the chest revealed marked dilatation of the left sinus of. Transcatheter closure of ruptured sinus valsalva aneurysm.
Sinus of valsalva aneurysm sva is a rare cardiac malformation, frequently originating from the right coronary sinus and less frequently from the noncoronary and left coronary sinuses. Aneurysm of the aortic sinus, also known as the sinus of valsalva, is a rare abnormality of the aorta, the largest artery in the body. Between 1956 and 1997, 129 patients presented with a ruptured 64. A depression or cavity formed by a bending or curving.
Pdf classical windsock deformity of ruptured sinus of valsalva. Pdf ruptured sinus of valsalva aneurysm researchgate. Most commonly it is associated with bicuspid aortic valves and to a lesser degree to other aortic abnormalities such as aortic root dilatation and aneurysms of the sinuses of valsalva. This video is about rsov patient who remained undiagnosed until dr a. Sinus of valsalva aneurysm involving right r and noncoronary n sinus with rupture through the noncoronary sinus into the right atrium indicated by the probe. Ruptured aneurysm of aortic sinus of valsalva into right atrium.
A sinus of valsalva aneurysm is a rare cardiac anomaly which may be acquired or congenital. Ruptured sinus of valsalva in an asymptomatic patient. Since the first successful repair reported by lillehei and colleagues in 1957,1 different surgical techniques including primary closure, patch closure, and different. A sinus of valsalva aneurysm sva is an uncommon cardiac anomaly that can be congenital or acquired. Sinus of valsalva aneurysm columbiadoctors new york. Echocardiography revealed ruptured sova from right coronary sinus to right atrium ra in 4. May 14, 2010 mean survival rate of patients with ruptured aneurysms of the sinus of valsalva is 12 years. The role of threedimensional echocardiography in diagnosis and management of ruptured sinus of valsalva aneurysm. Ruptured sinus of valsalva with ventricular septal defect. Although surgery is the gold standard treatment, percutaneous transcatheter closure has now become equally efficacious with fewer complications. Herein, we report the operative correction of thirtyone patients of ruptured aneurysms of the sinus of valsalva, using the onpump beatingheart technique. Introduction thin walled, saccular or tubular outpouchings, usually always in the right sinus or adjacent half of the noncoronary sinus.