Herein, we report the operative correction of thirtyone patients of ruptured aneurysms of the sinus of valsalva, using the onpump beatingheart technique. Despite surgical intervention the patient died before correction. Association of other cardiac lesions is common, including. Ruptured sinus of valsalva aneurysm can be closed by surgery or device closure, provided margins are adequate. Surgical repair of a ruptured congenital sinus of valsalva. May 14, 2010 rupture of aneurysms of the sinus of valsalva results in abrupt onset of congestive heart failure. Ruptured sinus of the valsalva aneurysm rsva is a rare cardiac anomaly. Ruptured aneurysm of the sinus of valsalva associated with an atrial septal aneurysm.
Successful surgical repair of a ruptured aneurysm of the. Jul 15, 2014 ruptured congenital aneurysm of the sinus of valsalva with persistent left superior vena cava imaged by intraoperative transesophageal echocardiography. Ruptured sinus of valsalva aneurysm rsva is a rare congenital cardiac anomaly,1, 2 albeit five times more frequent in asian populations than in western countries. Ruptured sinus of valsalva aneurysm rsva can be associated with ventricular septal defects or isolated lesions. A sinus of valsalva aneurysm is a rare cardiac anomaly which may be acquired or congenital. The origin of the ruptured aneurysm of the sinus of valsalva was the right coronary sinus in 12 patients, the noncoronary sinus in 4, and the left coronary sinus in one patient. The recognition of quadricuspid aortic valve has clinical significance as it causes aortic valve dysfunction, and is often associated with other congenital cardiac abnormalities. Rupture of aneurysms of the sinus of valsalva results in abrupt onset of congestive heart failure. Sova itself is uncommon, but it is more frequently associated with a supracristal ventricular septal defect svsd. The subject was a 35yearold male who complained to a coworker of shortness of breath and then collapsed and could not be resuscitated. Surgical treatment of aneurysm of the sinus of valsalva. Surgical correction of ruptured aneurysms of the sinus of. Sinus valsalva, ruptured aneurysm, congestive heart failure, echocardiography.
Coronary arteriovenous fistula and aortic sinus aneurysm rupture. This article is from journal of cardiovascular disease research, volume 3. Eight copies of format and eight copies each of important publications to be sent. Jul 01, 2015 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.
Modified sakakibara classification system for ruptured sinus. Ruptured sinus of valsalva how is ruptured sinus of. Ruptured sinus of valsalva jama surgery jama network. Ruptured sinus of valsalva aneurysm rsov, a rare but well recognized clinical entity, is invariably a form of lefttoright shunt due to rupture into rightsided chambers. Ruptured coronary sinus of valsalva in the setting of a. Clinical manifestations can vary from an incidental finding on an imaging study to a lifethreatening emergency.
However, reports on the surgical experience are scarce. Very late recurrence of sinus of valsalva aneurysm rupture. Acute rupture of a sinus of valsalva aneurysm into the. Ruptured sinus of valsalva aneurysm in a turners syndrome patient ruptured sinus of valsalva aneurysm in a turners syndrome patient tingler, david. Aug 04, 2019 an unruptured aneurysm of sinus of valsalva was diagnosed in childhood. A rare case of aorticoright ventricular tunnel along with. Acute heart failure with newonset continuous murmur in a. Sinus of valsalva aneurysm description, causes and risk factors.
Ruptured congenital aneurysms of the sinus of valsalva. Rupture of right coronary sinus of valsalva aneurysm into. Aneurysm of the sinus of valsalva is a rare congenital cardiac anomaly. This video is about rsov patient who remained undiagnosed until dr a. Most svas rupture into right heart chambers and can be classified using the modified sakakibara classification according to. 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.
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. Very late recurrence of ruptured sva after patch repair is extremely rare. Surgical treatment of ruptured aneurysm of aortic sinus. Transthoracic minimally invasive closure for the treatment. Ruptured sinus of valsalva aneurysm associated with aortic. Supplementary video file associated with this article. We are happy to report that this patient made a full recovery from his sinus of valsalva aneurysm rupture. A ruptured sva has a very poor prognosis with high morbidity and mortality. This technique can successfully characterize the shunt as well as determine the presence of associated anomalies, such as ventricular septation and aortic regurgitation. Ppt sinus valsalva aneurysm powerpoint presentation. Transthoracic color doppler echocardiography revealed ruptured non coronary sinus of valsalva to right ventricle with large left to right shunt, perimembraneous.
The entity of ruptured sinus of valsalva has been known to pathologists for many years, the first report having been published in 1840 by thurnam. Ruptured sinus of valsalva article pdf available in saudi medical journal 238. An unruptured aneurysm of sinus of valsalva was diagnosed in childhood. It is still rare to come across unruptured giant aneurysm with complete heart block, and these case reports are es. Untreated, it carries a risk of development of right ventricular rv overload and pulmonary hypertension. Introduction thin walled, saccular or tubular outpouchings, usually always in the right sinus or adjacent half of the noncoronary sinus. Rupture of right coronary sinus of valsalva aneurysm into right. Rupture sinus of valsalva in a patient with dextrocardia. Very late recurrence of sinus of valsalva aneurysm rupture after patch repair, bmc surgery, 2014, pp. 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. Ruptured aneurysm of an aortic sinus of valsalva is a rare cause of lefttoright shunting. Ruptured aneurysm of the left sinus of valsalva into the.
Kucukoglu s, ural e, mutlu h, ural d, sonmez b, uner s. Ruptured sinus of valsalva aneurysm into the left atrium with multiple fistulous communications. Sinus of valsalva aneurysm sova is a rare clinical entity. Rupture of the sinus of valsalva to the right ventricle medind. Percutaneous transcatheter closure of ruptured sinus of valsalva. The diagnosis of congenital sinus of valsalva aneurysms with acute rupture into the cardiac chambers should be strongly suspected in patients presenting with acute symptoms and a newonset continuous murmur. Sinus of valsalva aneurysms are a cause of thoracic aortic dilatation, arising from one of the aortic sinuses. A giant ruptured sinus of valsalva aneurysm was diagnosed on transthoracic and subsequent transesophageal echocardiography, in a 45yearold man who we use cookies to enhance your experience on our website.
We retrospectively analysed the cases of our centre to summarize our 10year experience. Arrows indicate common sites of rupture of sinus of valsalva aneurysm m membraneous septum nc noncoronary sinus v atrioventricular septum c conal septum. Aortoright atrial shunt due to perforated sinus of valsalva aneurysm duration. The pathological srno of deficiencies between the aortic root and the heart, including aortic sinus aneurysms. Prior to this admission, she had presented to the emergency. The conventional treatment of rsva is surgical repair under cardiopulmonary bypass cpb or percutaneous catheter closure. Ruptured sinus of valsalva aneurysm cath lab digest. Onpump beatingheart surgery may reduce cardiac impairment by maintaining coronary blood flow and avoiding cardioplegia. Ruptured sinus of valsalva aneurysm rsva is a rare car diac anomaly and is most commonly seen in the asian population. 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 sinus of valsalva aneurysm in adult age medigraphic. Nearly 80% of patients will have symptom when rsva ruptures into one of the cardiac chambers. Sva is a rare cardiac anomaly, and arises mainly from a congenital defect of the aortic media or may follow bacterial endocarditis.
Resonance imaging of a ruptured aneurysm of the sinus of valsalva. Here, we present one case of rsva undergo transthoracic minimally invasive closure, which is a novel. Valsalva sinus aneurysms vsa are rare defects, repre senting 0. Surgical repair of ruptured sinus of valsalva europe pmc. Abstracta young adult who presented with congestive heart failure was found to have. Quadricuspid aortic valve with ruptured sinus of valsalva. Echocardiogram and computed tomography angiography cta of the chest revealed marked dilatation of the left sinus of valsalva, measuring 7. Nov 30, 2016 this video is about rsov patient who remained undiagnosed until dr a.
Aneurysm of sinus of valsalva an overview sciencedirect. 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. Sinus of valsalva aneurysm sva is an uncommon cardiac defect accounting for only 1% of congenital cardiac anomalies and the most common complication is ruptured into the atrium or ventricle. The first reports of asv appeared in the 19 th century and lillehei et al. Few large or longterm series exist regarding the management of patients with sinus of valsalva aneurysms or fistulas svafs. Ruptured sinus of valsalva aneurysm can be closed by sur. Generally have an intracardiac course may protrude into the pericardial space and they may rupture into. Summary a sinus of valsalva aneurysm sva is a rare congenital. Aneurysm and fistula of the sinus of valsalva clinical considerations and surgical treatment in 45 pat ients. It causes profound hemodynamic effects, especially when the rupture is acute. Ruptured aneurysm of the sinus of valsalva into the left ventricle. A ruptured aneurysm typically leads to an aortocardiac shunt and progressively worsening heart failure. Background sinus of valsalva aneurysm sva is an uncommon cardiac defect accounting for only 1% of congenital cardiac anomalies and the most common complication is ruptured into the atrium or ventricle.
This patients diagnosis was made by recognizing abnormal oxygen saturations during a right heart catheterization shunt run and followup transthoracic echocardiogram using color. Cardiac catheterization and cardiac computed tomography are additional investigation needed for further evaluation and planning for the intervention needed. Aneurysms arising from the right coronary sinus are the most common, and usually extend and rupture into the rightside heart chambers. Transthoracic minimally invasive closure for the treatment of. We present a case of 57yearold man had received repair for ruptured sinus of valsalva aneurysm at 19 ages. Rupture of the sinus of valsalva rsov is an uncommon condition with a variety of manifestations ranging from an asymptomatic murmur to cardiogenic shock. Sinus of valsalva aneurysm rupture misdiagnosed as a. Unruptured right sinus of valsalva aneurysm dissecting into. Parasternal shortaxis at a level just above the aortic valve reveals the site of rupture within the right coronary sinus.
Ruptured sinus of valsalva aneurysm in a turners syndrome. Rupture of an aneurysm of the noncoronary sinus of valsalva into. Transthoracic echocardiographic imaging of a ruptured sinus of valsalva aneurysm. Ruptured right sinus of valsalva into main pulmonary artery. We show how resonance imaging can be used to make the diagnosis. A sinus of valsalva aneurysm sva is a rare cardiac anomaly. Percutaneous transcatheter closure of rsva has been an alternative strategy to.
Surgical treatment of ruptured aneurysms of the sinus of valsalva. Dissecting aneurysm of the interventricular septum due to. Surgical treatment of a giant unruptured aneurysm of the. Repair of ruptured sinus of valsalva aneurysm youtube. Lillihei, inperformed the first successful surgical intervention.
Ruptured congenital aneurysm of the sinus of valsalva with persistent left superior vena cava imaged by intraoperative transesophageal echocardiography. Mar 30, 2019 ruptured sinus of valsalva aneurysm in adult age. Sinus of valsalva aneurysm rupture misdiagnosed as a ventric. The symptomatic unruptured aneurysm always needs surgery. Acute rupture of a sinus of valsalva aneurysm into the right. We showed the important role of multimodality imaging in diagnosing a quadricuspid aortic valve associated with ruptured sinus of valsalva. We describe a case of ruptured sinus of valsalva aneurysm rsva with moderate aortic regurgitation ar, which developed on the second. Once ruptured, sinus of valsalva aneurysm may produce serious hemodynamic instability, such as acute heart failure or sudden death. We herewith report a case of ruptured sinus of valsalva into the right. The aneurysm can rupture into any cardiac chamber, most commonly in the rv and right atrium. Among the main complications of vsa are described aortic insufficiency, coronary artery compromise, diverse arrhythmias, rupture and endocarditis. Aneurysm of sinus of valsalva with report of two cases. The surgical repair of ruptured sinus of valsalva aneurysms.
Ppt sinus valsalva aneurysm powerpoint presentation free. Get a printable copy pdf file of the complete article 3. Repair of ruptured sinus of valsalva aneurysm ctsnetvideo. The main associated symptoms are conduction disturbances, myocardial ischemia, and syncopes. Ruptured aneurysm of the noncoronary sinus of valsalva ncbi. Aneurysm of sinus of valsalva genetic and rare diseases. Aneurysms may affect the right 6585%, noncoronary 1030%, or rarely the. We report a case of a 51yearold female with a large symptomatic left sova. It occurs as an outpouching that progresses like a windsock, and it may rupture producing aortic regurgitation, cardiac tamponade, congestive heart failure, conduction abnormalities, and stroke. A sinus of valsalva aneurysm is a rare cardiac pathology and has been described in previous echo rounds in this journal. Pdf percutaneous closure of a ruptured right coronary. Mayer ed, ruffmann k, saggau w, butzmann b, bernhardtmayer k, schatton n. Sinus of valsalva aneurysms are rare cardiac anomalies which may. Longterm outcome of surgical repair of ruptured sinus of.
Unruptured right sinus of valsalva aneurysm dissecting. Surgical intervention is the main treatment for a ruptured congenital sinus of valsalva aneurysm sva. Recently, a 67yearold female patient came to our attention after a collapse, due to cardiac tamponade caused by a ruptured sinus of valsalva aneurysm sva and intrapericardial bleeding. The development of a shunt between the sinus of valsalva and rightsided cardiac chambers results in a continuous murmur on examination. A ruptured sinus of valsalva is a rare cardiac anomaly. Sinus of valsalva aneurysm radiology reference article. A sinus of valsalva aneurysm sova is usually a silent entity until one of its complications arises, such as heart failure. Between 1956 and 1997, 129 patients presented with a ruptured 64. Aneurysm of the sinus of valsalva is an uncommon cardiac abnormality. By continuing to use our website, you are agreeing to our use of cookies. She had to and fro murmur, features of congestive cardiac failure. Aug 10, 20 repair of ruptured sinus of valsalva aneurysm ctsnetvideo. A ruptured sinus of valsalva aneurysm sva is a rare cardiac abnormality, and is associated with a severe lefttoright shunt if communicating with the rightsided. We report a case of a 21yearold male who suffered an aneurysm of the sinus of valsalva rupture into the.
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