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      A Short Case Report on Ruptured Sinus of Valsalva Aneurysm

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          Abstract

          A 35-year-old woman without any history of congenital heart disease presented to our clinic with dyspnea on exertion. Transthoracic echocardiogram (TTE) showed an eccentric tricuspid regurgitant jet and increased right ventricular systolic pressure. Transesophageal echocardiogram (TEE) revealed a sinus of Valsalva aneurysm (SVA) arising from the noncoronary sinus that ruptured into the right atrium, leading to the formation of an aorto-right atrial fistula. Right heart catheterization confirmed left to right shunt. The fistulous tract was resected, and the aneurysm repaired surgically. The patient made a good recovery.

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          Sinus of valsalva aneurysms: review of the literature and an update on management.

          Michael Weinreich, Pey-Jen Yu, Biana Trost (2015)
          Sinus of Valsalva aneurysm (SOVA), a congenital or acquired cardiac defect that is present in roughly 0.09% of the general population, often presents as an incidental finding during cardiac imaging. Although an echocardiogram is the standard imaging technique for such findings, cardiac computed tomography angiography (CCTA) has been increasingly utilized. If SOVA is diagnosed, CCTA is also a useful test for patients who are at low to intermediate risk for coronary artery disease (CAD) prior to surgical repair. CCTA can accurately rule out CAD, obviating the need for invasive angiography in most cases, which may be more risky in SOVA patients because their coronaries may be more difficult to engage and their aortic root may be more prone to injury. Although surgery has previously been the treatment of choice, transcatheter techniques have added to the spectrum of nonsurgical alternatives for repair. We report here 4 incidental SOVA cases and review the current literature.
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            Sinus of Valsalva aneurysm or fistula: management and outcome.

            Thomas Takach, George J Reul, J.Michael Duncan … (1999)
            Few large or long-term series exist regarding the management of patients with sinus of Valsalva aneurysms or fistulas (SVAFs). Between 1956 and 1997, 129 patients presented with a ruptured (64 cases; 49.6%) or nonruptured (65 cases; 50.4%) SVAF. The patients included 88 men and 41 women, with a mean age of 39.1 years. Associated findings included a history of endocarditis (42 cases; 32.6%), a bicuspid aortic valve (21 cases; 16.3%), a ventricular septal defect (15 cases; 11.6%), and Marfan's syndrome (12 cases; 9.3%). Operative procedures included simple plication (61 cases; 47.3%), patch repair (52 cases; 40.3%), aortic root replacement (16 cases; 12.4%), and aortic valve replacement/repair (75 cases; 58.1%). There were five in-hospital deaths (3.9%): four due to preexisting sepsis and endocarditis and one that followed dehiscence of the repair in a patient with Marfan's syndrome. Two patients (1.6%) had strokes during the early postoperative period. The survivors were followed up for 661.1 patient-years (5.3 years/patient). The following late complications occurred: prosthetic valve malfunction (5 cases; 3.9%), prosthetic valve endocarditis (3 cases; 2.3%), SVAF recurrence (2 cases; 1.6%), thrombosis (1 case; 0.8%), and anticoagulation-related bleeding (1 case; 0.8%). Resection and repair of SVAF entails an acceptably low operative risk and yields long-term freedom from symptoms. Early, aggressive treatment is recommended to prevent endocarditis or lesional enlargement, which causes worse symptoms and necessitates more extensive repair.
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              Valsalva sinus aneurysms: findings at CT and MR imaging.

              Aliye Bricker, Bindu Avutu, Tan-Lucien H Mohammed … (2010)
              Aneurysms of the Valsalva sinus (aortic sinus) can be congenital or acquired and are rare. They are more common among men than women and among Asians than other ethnic groups. Nonruptured aneurysms may be asymptomatic and incidentally discovered, or they may be symptomatic and manifest acutely with mass effect on adjacent cardiac structures. Ruptured Valsalva sinus aneurysms result in an aortocardiac shunt and may manifest as insidiously progressive congestive heart failure, severe acute chest pain with dyspnea, or, in extreme cases, cardiac arrest. Although both ruptured and nonruptured Valsalva sinus aneurysms may have potentially fatal complications, after treatment the prognosis is excellent. Thus, prompt and accurate diagnosis is critical. Most Valsalva sinus aneurysms are diagnosed on the basis of echocardiography, with or without angiography. However, both electrocardiographically gated computed tomography and magnetic resonance (MR) imaging can provide excellent anatomic depiction, and MR imaging can provide valuable functional information.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 5 September 2020
                Publication date (Electronic, collection): September 2020
                Volume: 12
                Issue: 9
                Electronic Location Identifier: e10263
                Affiliations
                [1 ] Internal Medicine, University of North Dakota School of Medicine, Fargo, USA
                [2 ] Interventional Cardiology, Pikeville Medical Center, Pikeville, USA
                Author notes
                Article
                DOI: 10.7759/cureus.10263
                PMC ID: 7537488
                SO-VID: 65d83e36-2a43-4846-b39e-a2d642353fa2
                Copyright © Copyright © 2020, Matta et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 26 August 2020
                Date accepted : 2 September 2020
                Categories
                Subject: Cardiology
                Subject: Internal Medicine
                Subject: Anatomy

                Keywords: ruptured sinus of valsalva aneurysm,aorto-atrial fistula,aorto-right atrial fistula,percutaneous closure of ruptured sinus of valsalva aneurysm,sinus of valsalva aneurysm,left to right shunt
                Data availability:
                Keywords: ruptured sinus of valsalva aneurysm, aorto-atrial fistula, aorto-right atrial fistula, percutaneous closure of ruptured sinus of valsalva aneurysm, sinus of valsalva aneurysm, left to right shunt

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