Ruptured valsalva sinus aneurysms result in an aorto cardiac shunt and may manifest as insidiously progressive congestive heart failure, severe acute chest. Sinus of valsalva aneurysm sova is a rare clinical entity. The aortic sinuses of valsalva are areas of dilatation of the aortic root that arise from the three cusps of the aortic valve 1. We describe a patient with an unruptured 10 cm aneurysm of the sinus of valsalva. Ruptured sinus of valsalva aneurysm rsva can be associated with ventricular septal defects or isolated lesions. The anterior aortic sinus gives rise to the right coronary artery. The ruptured sinus of valsalva aneurysm was repaired. Ruptured aneurysm of the noncoronary sinus of valsalva ncbi. Valsalva sinus the space between the superior aspect of each cusp of the aortic valve and the dilated portion of the wall of the ascending aorta. Ruptured sinus of valsalva in an asymptomatic patient. It has been reported that mitral stenosis is associated with the calcification of the mitral valve20 and coronary artery,2124 a giant aneurysm of the sinus of valsalva with calcification,24. On the other hand, there is limited data in the literature about congenital sinus of valsalva aneurysms outside this context. An aneurysm of the sinus of valsalva ruptures in 35%, leading to acute symptoms in onefourth of the patients. Memory lane 1839 1st description by hope 1840 1st important paper published by thurman 1949 jones and langley the subject of congenital and acquired lesion 1951 1st diagnosis of rupture during life by venning 1956 1st.
Aneurysm and fistula of the sinus of valsalva clinical considerations and surgical treatment in 45 pat ients. Aneurysm of the sinus of valsalva the british journal of. Sinus of valsalva aneurysm presenting as myocardial infarction during dobutamine stress test. Additional imaging techniques can be used to confirm the diagnosis. Ruptured aneurysm of the right sinus of valsalva associated with a ventricular septal defect and an anomalous coronary artery. Unruptured sinus of valsalva aneurysms usually do not cause any symptom and are often found during ec hocardiogram examination and cardiac catheterization. Aneurysms of the sinus of valsalva are rare and almost always originate from the right or non coronary sinuses. Carotid sinus massage is a simple bedside maneuver that helps to clarify the type and sometimes also the mechanism of different rhythm disturbances. 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. Abstract sinus of valsalva aneurysm sova, a congenital or acquired. Links to pubmed are also available for selected references.
Sinus of valsalva aneurysm with rupturing into the right atrium. We report a case of a 51yearold female with a large symptomatic left sova. The conventional treatment of rsva is surgical repair under cardiopulmonary bypass cpb or percutaneous catheter closure. Rupture of sinus of valsalva aneurysm type v sakakibara type. Ruptured sinus of valsalva aneurysm cath lab digest. Abstract an isolated unruptured aneurysm of the left coronary sinus of valsalva was detected inci dentally in a patient with a bicuspid aortic valve in. Valsalva sinus definition of valsalva sinus by medical. If timely intervention is not done, it leads to the deterioration of heart function. Full text full text is available as a scanned copy of the original print version. 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. Pdf aneurysms of the sinus of valsalva are extremely rare. Sep 19, 2016 a sinus of valsalva aneurysm is a rare cardiac anomaly which may be acquired or congenital.
An unruptured congenital sinus of valsalva aneurysm behind the right aortic valve cusp is described as an incidental necropsy finding in an. Surgical repair and longterm results in ruptured sinus of. Sep 15, 2008 a young male presented with acute chest pain. Aneurysm of sinus of valsalva genetic and rare diseases. Aneurysmal dilatation of the aortic sinuses of valsalva has been most extensively documented in the setting of aortopathies, particularly marfan syndrome. A sinus of valsalva aneurysm is a rare cardiac anomaly that may be congenital or acquired. Transthoracic echocardiographic imaging of a ruptured sinus of valsalva aneurysm. Usually, no vessels arise from the right posterior aortic sinus, which is therefore known as the noncoronary sinus. We report a rare case of ruptured aortic sinus of valsalva aneurysm into the main pulmonary artery. The right sinus of valsalva is directly related to the interventricular sep tum, and separation of these two structures with a resultant conal septal or perimembra nous ventricular septal defect vsd is seen in 3050% of patients with congenital sinus of valsalva aneurysms 15, 16. The name comes from the famed italian anatomist, antonia maria valsalva.
Unruptured aneurysm of the left sinus of valsalva causing. Transthoracic minimally invasive closure for the treatment of. Aneurysms arising from the right coronary sinus are the most common, and usually extend and rupture into the rightside heart chambers. A ruptured sinus of valsalva is a rare cardiac anomaly. Both the aortic valve and the sinus of valsalva were successfully repaired. In this case report, we describe a 65yearold asymptomatic patient with a continuous cardiac murmur leading to the diagnosis of a previously unsuspected ruptured sinus of valsalva. Rupture of right coronary sinus of valsalva aneurysm into. Hence, the presence of lefttoright shunt caused by ruptured aneurysms of the sinus of valsalva is an indication for surgical intervention. This patients diagnosis was made by recognizing abnormal oxygen saturations during a right heart catheterization shunt run and followup transthoracic echocardiogram using color doppler.
Ppt sinus valsalva aneurysm powerpoint presentation free. Contrastenhanced axial ct scans through the heart demonstrate an aneurysm black arrows of the right coronary sinus rc from which the right coronary artery arises red arrow. The first successful surgical repair by means of cardiopulmonary bypass was reported in 1957 by lillehei et al. 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. Parasternal shortaxis at a level just above the aortic valve reveals the site of rupture within the right coronary sinus. Nov 10, 2015 an acquired sinus of valsalva aneurysm is seen in conditions like tuberculosis, behcets disease, infective endocarditis and trauma. Sinus of valsalva aneurysm sva is a rare cardiac anomaly, and sva combined with right ventricular outflow tract stenosis is even rarer. Clinical manifestations can vary from an incidental finding on an imaging study to a lifethreatening emergency. Each aortic sinus can also be referred to as the sinus of valsalva, the sinus of morgagni, the sinus of mehta, the sinus of otto, or petits sinus. If the aneurysm ruptures, it causes acute symptoms of dyspnoea.
Pdf a giant aneurysm of the sinus of valsalva with. 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. There have been a few reported cases of unruptured sinus of valsalva aneurysms 2 but not in this size of aneurysm 10 cm. Pdf ruptured aneurysm of the right sinus of valsalva. Mean survival rate of patients with ruptured aneurysms of the sinus of valsalva is 12 years. We report an unusual case of ruptured sinus of valsalva aneurysm associated with endocarditis that was caused by streptococcus pneumoniae serotype 21. A ruptured aneurysm typically leads to an aortocardiac shunt and progressively worsening heart failure. Unruptured sinus of valsalva aneurysm american journal of. Thin walled, saccular or tubular outpouchings, usually always in the.
Unruptured sinus of valsalva aneurysm involving all three. Echocardiography diagnosis of ruptured congenital right. Five cases of congenital aneurysm of the aortic sinuses of valsalva and notes on the prognosis. The echocardiogram revealed enlargement of the right chambers and right coronary sinus of valsalva.
Sinus of valsalva aneurysms can present as subtle enlargement of an aortic sinus to tubularshaped projection that extends from the apex or body of the sinus 8. The subject was a 35yearold male who complained to a coworker of shortness of breath and then collapsed and could not be resuscitated. Ruptured sinus of valsalva how is ruptured sinus of. Aneurysmal dilatation of the aortic sinuses of valsalva. Jul 15, 2014 sinus of valsalva aneurysm sva is an uncommon cardiac anomaly that can be congenital or acquired. 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. In case of rupture, prognosis is poor and therefore repair is always required.
Aneurysm of sinus of valsalva an overview sciencedirect. Unruptured, they normally remain clinically silent detected by routine echocardiography but can cause right ventricular outflow tract obstruction, aortic regurgitation and myocardial ischaemia from coro. Untreated, it carries a risk of development of right ventricular rv overload and pulmonary hypertension. Once ruptured, sinus of valsalva aneurysm may produce serious hemodynamic instability, such as acute heart failure or sudden death. Sep 05, 2017 a tutorial about sinus valsalva aneurysm.
The left coronary artery yellow arrow arises form the left coronary sinus lc. The surgical repair of ruptured sinus of valsalva aneurysms. A third sinus of valsalva is referred to as the noncoronary sinus, as it does not lead to a coronary artery. Sinus of valsalva aneurysms rarely present until rupture occurs. We retrospectively analyzed 222 patients receiving. Three cases of ruptured aneurysm of the aortic sinus of valsalva one each into the right atrium, right ventricle and pulmonary artery are reported and clinical as well as haemodynamic features. While most of the times it ruptures into the right ventricle or right atrium, rupture into the pulmonary artery is rare,2 accounting for less than 2 % of all ruptured sinuses of valsalva. A free powerpoint ppt presentation displayed as a flash slide show on id.
Sinus of valsalva aneurysm prepost tricuspid lr shunt 2. Isolated unruptured aneurysm of the left coronary sinus of valsalva. Sinuses of valsalva article about sinuses of valsalva by. Both ruptured and nonruptured sovas can be complicated by aortic.
The main associated symptoms are conduction disturbances, myocardial ischemia, and syncopes. Surgical treatment of a giant unruptured aneurysm of the. Introduction thin walled, saccular or tubular outpouchings, usually always in the right sinus or adjacent half of the noncoronary sinus. In this report we describe a 52yearold albanian woman from kosovo with an unruptured aneurysm of 74. Transthoracic color doppler echocardiography revealed ruptured non coronary sinus of valsalva to right ventricle with large left to right shunt. A ruptured sinus of valsalva rsov aneurysm is associated with a severe lefttoright shunt when it communicates with the rightsided heart chambers. Both contrast and colordoppler techniques showed shunting from the sinus of valsalva with the typical wind sock appearance into the right ventricle 17 and, passing through the tricuspidal leaflets, into the right atrium fig. Aneurysm of the sinus of valsalva is an uncommon cardiac abnormality. Surgical findings included a large fistulous tract between the noncoronary sinus of valsalva and the ra measuring approximately 9 mm in diameter. Sinus of valsalva medical definition merriamwebster. Ruptured sinus of the valsalva aneurysm rsva is a rare cardiac anomaly. Get a printable copy pdf file of the complete article 673k, or click on a page image below to browse page by page. Generally have an intracardiac course may protrude into the pericardial space and they may rupture into.
The sinus of valsalva aneurysm, like many other congenital cardiac lesions, has to be defined carefully before its devastating results occur. We describe the case of a patient who presented with acute right heart failure and upon investigation was found to have an unruptured sinus of valsalva aneurysm causing right ventricular outflow obstruction. Sinuses of valsalva definition of sinuses of valsalva by. Severe dilatation of coronary artery ostium complicating sinus of valsalva aneurysm.
Aneurysm of the sinus of valsalva is a rare anomaly that can be congenital or acquire. At the present time echocardiography has be come the election diagnostic method. Here, we present one case of rsva undergo transthoracic minimally invasive closure, which is a novel. Ruptured aneurysm of the noncoronary sinus of valsalva. Aneurysm of the left sinus of valsalva is extremely rare. Surgical correction of ruptured aneurysms of the sinus of. Doppler color flow mapping detection of ruptured sinus of. Congestive heart failure is known to be the main cause of death. Unruptured sinus of valsalva aneurysm obstructing the left.
Echocardiogram and computed tomography angiography cta of the chest revealed marked dilatation of the left sinus of valsalva, measuring 7. Echocardiography and cardiac magnetic resonance imaging. We report a case of a 21yearold male who suffered an aneurysm of the sinus of valsalva rupture into the. An aortic valve leaflet was perforated, likely by a bullet fragment. We present two pediatric patients with unrupture aneurysm of the sinus of valsalva and cardiac failure secondary to a. Jul 01, 2001 although first reports of sinus of valsalva aneurysms svas appeared in the literature as early as in the nineteenth century, few large or longterm series are currently available. 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. Mar 11, 2020 the left aortic sinus leads to the left coronary artery, and the right aortic sinus leads to the right coronary artery. Ruptured sinus of valsalva aneurysm sva is a rare cardiac lesion, and its incidence among all patients who have undergone cardiopulmonary bypass is. Compression of the left coronary artery by such an aneurysm is an unusual complication of this condition and can cause coronary insufficiency. Nearly 80% of patients will have symptom when rsva ruptures into one of the cardiac chambers. Percutaneous transcatheter closure of rsva has been an alternative strategy to. Aortic sinus aneurysm with communications into the right ventricle and associated ventricular septal defect. The most common among the acquire is aortic endocarditis.