Onpump beatingheart surgery may reduce cardiac impairment by maintaining coronary blood flow and avoiding cardioplegia. Transthoracic color doppler echocardiography revealed ruptured non coronary sinus of valsalva to right ventricle with large left to right shunt, perimembraneous sub. We report a case of a 21yearold male who suffered an aneurysm of the sinus of valsalva rupture into the. Transthoracic echocardiography atoc,online video 1 demonstrated the vsd with 2 overlapping velocities on continuouswave doppler d. Ruptured sinus of valsalva rsov is a relatively uncommon. Transesophageal echocardiography tee confirmed a rupture of sinus of valsalva aneurysm and ventricular septal defect. It is more prevalent in men and people of asian descent.
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. Aortic regurgitation ar is a common valvular insufficiency. Ruptured sinus of valsalva aneurysm from the left coronary sinus communicating through the mitral. Ruptured sinus of valsalva in an asymptomatic patient. Ruptured sinus of valsalva how is ruptured sinus of. Several approaches for repair, through the aortic root or the chamber into which the aneurysm ruptures or a combination of both, have been described. Herein, we report the operative correction of thirtyone patients of ruptured aneurysms of the sinus of valsalva, using the on. Percutaneous closure of a ruptured sinus of valsalva aneurysm using the amplatzer duct occluder. Surgical treatment of aneurysm of the sinus of valsalva. Rupture of aneurysms of the sinus of valsalva results in abrupt onset of congestive heart failure. Successful repair of these aneurysms was first described in the late 1950s. 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.
Color doppler imaging showed marked turbulent flow from the aortic aneurysm into the rv. 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. Nov 30, 2016 this video is about rsov patient who remained undiagnosed until dr a. Since the first successful repair reported by lillehei and colleagues in 1957,1 different surgical techniques including primary closure, patch closure, and different. Ruptured sinus of valsalva aneurysm rsva is relatively common in oriental patients. The relation between the rupture, right atrium ra, and aortic valve ao can be clearly seen b, online videos 2 and 3.
Abstracta young adult who presented with congestive heart failure was found to have. 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. An electrocardiogram showed firstdegree atrioventricular block, while the his bundle electrogram demonstrated the. A sinus of valsalva aneurysm sva is an uncommon cardiac anomaly that can be congenital or acquired. Rare case of ruptured sinus of valsalva aneurysm presenting only with diastolic.
Sinus of valsalva aneurysm sva occurs infrequently, with an incidence of 0. 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 are not aware of any other ruptured sva case associated with doublechambered right ventri. Pdf ruptured sinus of valsalva aneurysm researchgate. Sinus of valsalva aneurysm and fistula springerlink. Aortotomy was used in three patients and both routes were used in three patients. We report an unusual case of ruptured sinus of valsalva aneurysm associated with endocarditis that was caused by streptococcus pneumoniae serotype 21. Ruptured sinus of the valsalva aneurysm rsva is a rare cardiac anomaly. 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. These two echocardiographic findings should alert the clinician to a diagnosis of a ruptured sinus of valsalva aneurysm. 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. Transthoracic minimally invasive closure for the treatment of.
Echocardiogram and computed tomography angiography cta of the chest revealed marked dilatation of the left sinus of valsalva, measuring 7. We retrospectively analyzed 67 patients receiving repair of rsva in a beijing hospital over 5 years. Severe aortic regurgitation after repair of ruptured sinus. 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. The subject was a 35yearold male who complained to a coworker of shortness of. 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. An aortic valve leaflet was perforated, likely by a bullet fragment. The development of a shunt between the sinus of valsalva and rightsided cardiac chambers results in a continuous. Surgical findings included a large fistulous tract between the noncoronary sinus of valsalva and the ra measuring approximately 9 mm in diameter. Transcatheter closure of ruptured sinus of valsalva. Ruptured sinus valsalva aneurysm how is ruptured sinus.
A case of sinus of valsalva aneurysm rupture in a patient with. Aortic root injection revealed rupture sinus of valsalva to the right ventricle, video 39. Ruptured sinus of valsalva rsov is a relatively uncommon cause of acute haemodynamic worsening which is usually seen in youngaged or middleaged individuals. Transcatheter closure of ruptured sinus of valsalva aneurysm in a.
A ruptured sinus of valsalva aneurysm results in a communication between the aortic sinus and the atrium or right ventricle. Herein, we report the operative correction of thirtyone patients of ruptured aneurysms of the sinus of valsalva, using the onpump beatingheart technique. Repair was achieved through an incision in the cardiac chamber of the fistula exit in 61 patients. Between 1956 and 1997, 129 patients presented with a ruptured 64. 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 aneurysm rsva is traditionally repaired by surgery but more recently. The patient with this unusual diagnosis and presentation was managed successfully. Echocardiogram and computed tomography angiography cta of the chest revealed marked dilatation of the left sinus of. Between october 1, 1996 and september 30, 2001, at fu wai hospital, 67 patients with rsva underwent surgical repair, 0. A case of sinus of valsalva aneurysm rupture in a patient with bicuspid aortic valve. The role of threedimensional echocardiography in diagnosis and management of ruptured sinus of valsalva aneurysm. Acute rupture of a sinus of valsalva aneurysm into the right. Surgery has good reputation having a 2 transcatheter closure tcc of ruptured sinus of valsalva aneurysm rsova appears to be a reasonable alternative.
Rupture of an aneurysm of the sinus of valsalva, with consequent abrupt hemodynamic changes, entails a heavy cardiac load and progressive cardiac failure. Emergency surgery for ruptured sinus of valsalva aneurysms. 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 rupture of a sinus of valsalva is a rare cardiac anomaly, mostly occuring in aneurysmal dilated sinuses. We present a case of a 23yearold man who presented with a 20day history of symptoms of worsening breathlessness. Surgical treatment of a giant unruptured aneurysm of the. Unusual presentation and rupture of left sinus of valsalva. This video is about rsov patient who remained undiagnosed until dr a. The transthoracic echocardiogram showed noncoronary sinus of valsalva. Here, we present one case of rsva undergo transthoracic. Introduction thin walled, saccular or tubular outpouchings, usually always in the right sinus or adjacent half of the noncoronary sinus.
Jun 23, 2016 sinus of valsalva anuerysm with flow into the right ventricular outflow tract. The right sinus of valsalva is the most common site of aortic sinus aneurysmal dilatation, followed by the noncoronary sinus. A sinus of valsalva aneurysm is a rare cardiac anomaly which may be acquired or congenital. Sinus of valsalva aneurysm sva is a rare cardiac anomaly which has potential for spontaneous rupture into other cardiac chambers or the pericardial space depending on its location. A right anterior oblique view of aortogram demonstrating ruptured sinus of valsalva aneurysm into the right atrium. Surgical correction of ruptured aneurysms of the sinus of.
Video sequence the video sequence is available to view here. Ruptured aneurysm of aortic sinus of valsalva into right atrium. Although surgery is the gold standard treatment, percutaneous transcatheter closure has now become equally efficacious with fewer complications. Realtime threedimensional transesophageal echocardiography. Ruptured sva can be associated with various congenital heart defects. Three dimensional midsophageal aortic valve short axis view video showing the. The diagnosis of ruptured sinus of valsalva aneurysm should be suspected in patients presenting with acute haemodynamic compromise and cardiac murmurs. Ruptured sinus of valsalva aneurysm rsva can be associated with ventricular septal defects or isolated lesions. Threedimensional echocardiography etoh,online videos 2, 3, and 4 demonstrated vsd below the aortic valve and ruptured sinus of valsalva rsov into the right ventricle above the aortic valve.
Pdf classical windsock deformity of ruptured sinus of valsalva. In our patient, there was ruptured sinus of valsalva aneurysm and a small aortic root abscess with small multiple vegetations 23 mm in size. 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.
Presentation varies from asymptomatic findings to acute heart failure, which can rapidly worsen to cause death. Sinus of valsalva aneurysm description, causes and risk factors. Aneurysm of sinus of valsalva genetic and rare diseases. Sinus of valsalva anuerysm with flow into the right ventricular outflow tract. Sinus of valsalva aneurysm medication medscape reference. We have seen a case of rupture of an aneurysm of the noncoronary sinus into the right atrium.
Rupture of sinus of valsalva with endocarditis and aortic. Ruptured congenital aneurysm of the sinus of valsalva with persistent left superior vena cava imaged by intraoperative transesophageal echocardiography. 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. Video 1 parasternal short axis view showing the classical windsock. Congestive heart failure is known to be the main cause of death. 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. We report a case of a 21yearold male who suffered an aneurysm of. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only.
Parasternal shortaxis at a level just above the aortic valve reveals the site of rupture within the right coronary sinus. Sinus of valsalva aneurysm sova is a rare clinical entity. This article is from journal of cardiovascular disease research, volume 3. Severe pulmonary hypertension pasp at least 70 mm hg. Recording made with a thinklabs one digital stethoscope. Transthoracic echocardiographic imaging of a ruptured sinus of valsalva aneurysm. The conventional treatment of rsva is surgical repair under cardiopulmonary bypass cpb or percutaneous catheter closure. Sinus of valsalva aneurysm columbiadoctors new york. Definitive diagnosis often requires cardiac catheterisation and unless endocarditis is suspected, an aortogram should be performed. The main associated symptoms are conduction disturbances, myocardial ischemia, and syncopes. The development of a shunt between the sinus of valsalva and rightsided cardiac chambers results in a continuous murmur on examination. Echocardiographic diagnosis of ruptured right sinus of valsalva.
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. We report a case of a 51yearold female with a large symptomatic left sova. The patient was successfully operated with resection of the aneurysm and reconstruction of the sinus with xenopericard and recovered completely. Advance articles editors choice podcasts cardio image bank cme ehj today videos open access articles. Cardiac tamponade may occur if the rupture involves the pericardial space. Transcatheter closure of ruptured sinus of valsalva aneurysm using.
Sinus of valsalva aneurysm medigoo health medical tests. 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. Both the aortic valve and the sinus of valsalva were successfully repaired. A depression or cavity formed by a bending or curving. 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. Surgery was suggested even tough the patient was asymptomatic. 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. Repair of a sinus of valsalva aneurysm that had ruptured into. 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. Aug 31, 2011 after repair, patients lifeexpectancy approximates that of the healthy population. Severe aortic regurgitation after repair of ruptured sinus of. The delivery cardiac chamber of a right aortic sinus fistula is typically the.
Jeyamalar summary over a period ofnine years, from june 1976 through may 1985, 18 cases ofruptured sinus of. 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. Ruptured sinus of valsalva in an asymptomatic patient a case report. We are happy to report that this patient made a full recovery from his sinus of valsalva aneurysm rupture. Acute rupture of noncoronary sinus of valsalva aneurysm into the. Sva are asymptomatic unless they compress adjacent structures, form a thrombus, or rupture causing left to right shunting or aortic valve. Sinus of valsalva synonyms, sinus of valsalva pronunciation, sinus of valsalva translation, english dictionary definition of sinus of valsalva. 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. Aneurysm of sinus of valsalva an overview sciencedirect.
Ruptured aneurysm of the noncoronary sinus of valsalva. A ruptured aneurysm typically leads to an aortocardiac shunt and progressively worsening heart failure. May 14, 2010 mean survival rate of patients with ruptured aneurysms of the sinus of valsalva is 12 years. Transthoracic echocardiography revealed a ruptured sinus of valsalva sov, which was confirmed on transesophageal echocardiography tee a, online video 1.
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. Nearly 80% of patients will have symptom when rsva ruptures into one of the cardiac chambers. The relation between the rupture, right atrium ra, and aortic valve ao can be clearly seen b. A ruptured sva has a very poor prognosis with high morbidity and mortality. The ruptured sinus of valsalva aneurysm was repaired. Classical windsock deformity of ruptured sinus of valsalva. A ruptured sov aneurysm presents a clinical emergency and can lead to progressively deteriorating heart failure.
The abnormality is often congenital, but may also be acquired from endocarditis or trauma. Mayer ed, ruffmann k, saggau w, butzmann b, bernhardtmayer k, schatton n. 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. The defect is adjacent to the aortic valve and may be associated with a leak in the valve. Echocardiography revealed ruptured sova from right coronary sinus to right atrium ra in 4. 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. Hence, the presence of lefttoright shunt caused by ruptured aneurysms of the sinus of valsalva is an indication for surgical intervention. 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.
The sinus of valsalva was repaired with either a patch n 63 or direct sutures n 4. Ruptured sinus of valsalva aneurysm is a rare cardiac anomaly. Clinical manifestations can vary from an incidental finding on an imaging study to a lifethreatening emergency. Ruptured aneurysm of aortic sinus of valsalva into right. Generally have an intracardiac course may protrude into the pericardial space and they may rupture into.
Ruptured sinus of valsalva aneurysm sova is a rare but. However, sova with aortic root abscess has rarely been reported. 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. Jul 15, 2014 the role of threedimensional echocardiography in diagnosis and management of ruptured sinus of valsalva aneurysm. Rupture of a giant aneurysm of the sinus of valsalva leading. A ruptured sinus of valsalva is a rare cardiac anomaly. Aneurysms may affect the right 6585%, noncoronary 1030%, or. 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.
A ruptured sinus of valsalva aneurysm is a very rare cardiac anomaly. 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 surgical repair of ruptured sinus of valsalva aneurysms. An asymptomatic 23yearold man was noted to have a harsh pansystolic murmur on examination. With corrective surgery, there is a 94% survival rate at 10 years. 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.
Acute rupture of a sinus of valsalva aneurysm into the. Successful device closure of a ruptured sinus of valsalva. 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. Here, we present one case of rsva undergo transthoracic minimally invasive closure, which is a novel.