This video is about rsov patient who remained undiagnosed until dr a. A sinus of valsalva aneurysm sva is an uncommon cardiac anomaly that can be congenital or acquired. Sinuses of valsalva definition of sinuses of valsalva by. Three dimensional midsophageal aortic valve short axis view video showing the. The defect is adjacent to the aortic valve and may be associated with a leak in the valve. Acute rupture of a sinus of valsalva aneurysm into the. Transcatheter closure of ruptured sinus of valsalva aneurysm using. Severe aortic regurgitation after repair of ruptured sinus of. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. The relation between the rupture, right atrium ra, and aortic valve ao can be clearly seen b, online videos 2 and 3. A sinus of valsalva aneurysm is a rare cardiac anomaly which may be acquired or congenital. Sinus of valsalva anuerysm with flow into the right ventricular outflow tract. A ruptured sinus of valsalva is a rare cardiac anomaly.
Ruptured sinus of the valsalva aneurysm rsva is a rare cardiac anomaly. Between october 1, 1996 and september 30, 2001, at fu wai hospital, 67 patients with rsva underwent surgical repair, 0. 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. Surgery was suggested even tough the patient was asymptomatic.
Acute rupture of a sinus of valsalva aneurysm into the right. 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. Minimal tricuspid regurgitation and minimal mitral regurgitation. Ruptured sinus of valsalva with ventricular septal defect. Aug 31, 2011 after repair, patients lifeexpectancy approximates that of the healthy population.
Severe pulmonary hypertension pasp at least 70 mm hg. Rupture of a giant aneurysm of the sinus of valsalva leading. With corrective surgery, there is a 94% survival rate at 10 years. 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. However, sova with aortic root abscess has rarely been reported. 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. Pdf classical windsock deformity of ruptured sinus of valsalva. Transthoracic echocardiography revealed a ruptured sinus of valsalva sov, which was confirmed on transesophageal echocardiography tee a, online video 1. Ruptured sinus of valsalva aneurysm rsva is relatively common in oriental patients.
Video 1 parasternal short axis view showing the classical windsock. Echocardiography revealed ruptured sova from right coronary sinus to right atrium ra in 4. Generally have an intracardiac course may protrude into the pericardial space and they may rupture into. 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. Aneurysms may affect the right 6585%, noncoronary 1030%, or. Rupture of a giant aneurysm of the sinus of valsalva. Transthoracic minimally invasive closure for the treatment of. 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.
Advance articles editors choice podcasts cardio image bank cme ehj today videos open access articles. Nearly 80% of patients will have symptom when rsva ruptures into one of the cardiac chambers. A ruptured aneurysm typically leads to an aortocardiac shunt and progressively worsening heart failure. 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. The role of threedimensional echocardiography in diagnosis and management of ruptured sinus of valsalva aneurysm. Jul 15, 2014 the role of threedimensional echocardiography in diagnosis and management of ruptured sinus of valsalva aneurysm. Realtime threedimensional transesophageal echocardiography. Video sequence the video sequence is available to view here. 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. Rare case of ruptured sinus of valsalva aneurysm presenting only with diastolic. Repair was achieved through an incision in the cardiac chamber of the fistula exit in 61 patients. Here, we present one case of rsva undergo transthoracic.
Echocardiographic diagnosis of ruptured right sinus of valsalva. The abnormality is often congenital, but may also be acquired from endocarditis or trauma. 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. 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. Ruptured sinus valsalva aneurysm how is ruptured sinus.
We are happy to report that this patient made a full recovery from his sinus of valsalva aneurysm rupture. 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 sinus of valsalva was repaired with either a patch n 63 or direct sutures n 4. 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. 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. It is more prevalent in men and people of asian descent. Transthoracic minimally invasive closure for the treatment. Cardiac tamponade may occur if the rupture involves the pericardial space. The patient was taken to the intensive care unit for haemofiltration before transfer for emergency repair of the ruptured sinus the same day. We are not aware of any other ruptured sva case associated with doublechambered right ventri. Severe aortic regurgitation after repair of ruptured sinus. Ruptured sinus of valsalva rsov is a relatively uncommon cause of acute haemodynamic worsening which is usually seen in youngaged or middleaged individuals. Congestive heart failure is known to be the main cause of death. Surgical treatment of aneurysm of the sinus of valsalva.
A ruptured sva has a very poor prognosis with high morbidity and mortality. We report a case of a 51yearold female with a large symptomatic left sova. 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. Aortic regurgitation ar is a common valvular insufficiency. The development of a shunt between the sinus of valsalva and rightsided cardiac chambers results in a continuous murmur on examination. An aortic valve leaflet was perforated, likely by a bullet fragment. A depression or cavity formed by a bending or curving. The patient was successfully operated with resection of the aneurysm and reconstruction of the sinus with xenopericard and recovered completely. Unusual presentation and rupture of left sinus of valsalva. We report a case of a 21yearold male who suffered an aneurysm of the sinus of valsalva rupture into the.
Aneurysm of the sinus of valsalva is an uncommon cardiac abnormality. Sinus of valsalva aneurysm sova is a rare clinical entity. The delivery cardiac chamber of a right aortic sinus fistula is typically the. Transthoracic color doppler echocardiography revealed ruptured non coronary sinus of valsalva to right ventricle with large left to right shunt, perimembraneous sub. Successful repair of these aneurysms was first described in the late 1950s. We report a case of a 21yearold male who suffered an aneurysm of. Mayer ed, ruffmann k, saggau w, butzmann b, bernhardtmayer k, schatton n.
An asymptomatic 23yearold man was noted to have a harsh pansystolic murmur on examination. Ruptured sinus of valsalva aneurysm sova is a rare but. Ruptured congenital aneurysm of the sinus of valsalva with persistent left superior vena cava imaged by intraoperative transesophageal echocardiography. Here, we present one case of rsva undergo transthoracic minimally invasive closure, which is a novel. Aneurysm of sinus of valsalva an overview sciencedirect. A ruptured sov aneurysm presents a clinical emergency and can lead to progressively deteriorating heart failure. A rupture of a sinus of valsalva is a rare cardiac anomaly, mostly occuring in aneurysmal dilated sinuses.
The conventional treatment of rsva is surgical repair under cardiopulmonary bypass cpb or percutaneous catheter closure. Sinus of valsalva aneurysm description, causes and risk factors. In our patient, there was ruptured sinus of valsalva aneurysm and a small aortic root abscess with small multiple vegetations 23 mm in size. Ruptured sinus of valsalva aneurysm cath lab digest. Hence, the presence of lefttoright shunt caused by ruptured aneurysms of the sinus of valsalva is an indication for surgical intervention.
We report an unusual case of ruptured sinus of valsalva aneurysm associated with endocarditis that was caused by streptococcus pneumoniae serotype 21. The right sinus of valsalva is the most common site of aortic sinus aneurysmal dilatation, followed by the noncoronary sinus. Ruptured aneurysm of aortic sinus of valsalva into right atrium. 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. Repair of a sinus of valsalva aneurysm that had ruptured into. Sinus of valsalva definition of sinus of valsalva by the. Ruptured sinus of valsalva aneurysm is a rare cardiac anomaly. A case of sinus of valsalva aneurysm rupture in a patient with. Ruptured aneurysm of aortic sinus of valsalva into right. Ruptured sinus of valsalva aneurysm from the left coronary sinus communicating through the mitral. The subject was a 35yearold male who complained to a coworker of shortness of. This patients diagnosis was made by recognizing abnormal oxygen saturations during a right heart catheterization shunt run and followup transthoracic echocardiogram using color. Ruptured sva can be associated with various congenital heart defects.
The patient with this unusual diagnosis and presentation was managed successfully. A ruptured sinus of valsalva aneurysm is a very rare cardiac anomaly. Emergency surgery for ruptured sinus of valsalva aneurysms. The ruptured sinus of valsalva aneurysm was repaired. Surgical findings included a large fistulous tract between the noncoronary sinus of valsalva and the ra measuring approximately 9 mm in diameter. Echocardiogram and computed tomography angiography cta of the chest revealed marked dilatation of the left sinus of. Herein, we report the operative correction of thirtyone patients of ruptured aneurysms of the sinus of valsalva, using the on. A ruptured sinus of valsalva aneurysm results in a communication between the aortic sinus and the atrium or right ventricle. Ruptured sinus of valsalva aneurysm rsva can be associated with ventricular septal defects or isolated lesions. Ruptured sinus of valsalva how is ruptured sinus of.
The diagnosis of ruptured sinus of valsalva aneurysm should be suspected in patients presenting with acute haemodynamic compromise and cardiac murmurs. Successful device closure of a ruptured sinus of valsalva. Aortic root injection revealed rupture sinus of valsalva to the right ventricle, video 39. Acute rupture of noncoronary sinus of valsalva aneurysm into the. The transthoracic echocardiogram showed noncoronary 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. Between 1956 and 1997, 129 patients presented with a ruptured 64. Echocardiogram and computed tomography angiography cta of the chest revealed marked dilatation of the left sinus of valsalva, measuring 7. Sinus of valsalva aneurysm columbiadoctors new york. Ruptured sinus of valsalva rsov is a relatively uncommon. A case of sinus of valsalva aneurysm rupture in a patient with bicuspid aortic valve. We present a case of a 23yearold man who presented with a 20day history of symptoms of worsening breathlessness. Abstracta young adult who presented with congestive heart failure was found to have.
Percutaneous closure of a ruptured sinus of valsalva aneurysm using the amplatzer duct occluder. We retrospectively analyzed 67 patients receiving repair of rsva in a beijing hospital over 5 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. Parasternal shortaxis at a level just above the aortic valve reveals the site of rupture within the right coronary sinus. 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. Rare case of ruptured sinus of valsalva aneurysm presenting only. Sinus of valsalva synonyms, sinus of valsalva pronunciation, sinus of valsalva translation, english dictionary definition of sinus of valsalva. This article is from journal of cardiovascular disease research, volume 3. Ascending aortic pressure was 10549 mm hg and an aortogram confirmed a sinus of valsalva rupture into the right atrium see panel. Rupture of aneurysms of the sinus of valsalva results in abrupt onset of congestive heart failure. An electrocardiogram showed firstdegree atrioventricular block, while the his bundle electrogram demonstrated the. 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. Sinus of valsalva aneurysm sva occurs infrequently, with an incidence of 0.
Transcatheter closure of ruptured sinus valsalva aneurysm. 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. 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. Ruptured sinus of valsalva in an asymptomatic patient a case report. Ruptured sinus of valsalva in an asymptomatic patient.
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. Surgery has good reputation having a 2 transcatheter closure tcc of ruptured sinus of valsalva aneurysm rsova appears to be a reasonable alternative. Ruptured aneurysm of the noncoronary sinus of valsalva. 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.
Transthoracic echocardiographic imaging of a ruptured sinus of valsalva aneurysm. Jeyamalar summary over a period ofnine years, from june 1976 through may 1985, 18 cases ofruptured sinus of. Repair of a sinus of valsalva aneurysm that had ruptured. Rupture of an aneurysm of the sinus of valsalva, with consequent abrupt hemodynamic changes, entails a heavy cardiac load and progressive cardiac failure. Definitive diagnosis often requires cardiac catheterisation and unless endocarditis is suspected, an aortogram should be performed. Transesophageal echocardiography tee confirmed a rupture of sinus of valsalva aneurysm and ventricular septal defect. 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.
Surgical treatment of a giant unruptured aneurysm of the. Sinus of valsalva aneurysm medigoo health medical tests. May 14, 2010 mean survival rate of patients with ruptured aneurysms of the sinus of valsalva is 12 years. The main associated symptoms are conduction disturbances, myocardial ischemia, and syncopes. Since the first successful repair reported by lillehei and colleagues in 1957,1 different surgical techniques including primary closure, patch closure, and different. 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. The development of a shunt between the sinus of valsalva and rightsided cardiac chambers results in a continuous. Although surgery is the gold standard treatment, percutaneous transcatheter closure has now become equally efficacious with fewer complications. Aortotomy was used in three patients and both routes were used in three patients.
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. Rupture of sinus of valsalva with endocarditis and aortic. Presentation varies from asymptomatic findings to acute heart failure, which can rapidly worsen to cause death. Sinus of valsalva aneurysm medication medscape reference. Transthoracic echocardiography atoc,online video 1 demonstrated the vsd with 2 overlapping velocities on continuouswave doppler d. Surgical correction of ruptured aneurysms of the 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. Onpump beatingheart surgery may reduce cardiac impairment by maintaining coronary blood flow and avoiding cardioplegia. Ruptured sinus of valsalva aneurysm rsva is traditionally repaired by surgery but more recently. Recording made with a thinklabs one digital stethoscope. These two echocardiographic findings should alert the clinician to a diagnosis of a ruptured sinus of valsalva aneurysm. Sinus of valsalva aneurysm and fistula springerlink.
We have seen a case of rupture of an aneurysm of the noncoronary sinus into the right atrium. Jun 23, 2016 sinus of valsalva anuerysm with flow into the right ventricular outflow tract. Both the aortic valve and the sinus of valsalva were successfully repaired. A right anterior oblique view of aortogram demonstrating ruptured sinus of valsalva aneurysm into the right atrium. Pdf ruptured sinus of valsalva aneurysm researchgate. Sva are asymptomatic unless they compress adjacent structures, form a thrombus, or rupture causing left to right shunting or aortic valve. Transcatheter closure of ruptured sinus of valsalva aneurysm in a. Transcatheter closure of ruptured sinus of valsalva. 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.
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. Few large or longterm series exist regarding the management of patients with sinus of valsalva aneurysms or fistulas svafs. Color doppler imaging showed marked turbulent flow from the aortic aneurysm into the rv. Nov 30, 2016 this video is about rsov patient who remained undiagnosed until dr a. 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. Clinical manifestations can vary from an incidental finding on an imaging study to a lifethreatening emergency. Classical windsock deformity of ruptured sinus of valsalva.