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      A rare case of unruptured aneurysm of left coronary sinus of Valsalva accompanied with patent foramen ovale and atrial fibrillation detected after cardiac etiology stroke

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          Abstract

          We present a rare case of a 74 year old female with unruptured aneurysm of the left coronary sinus of Valsalva accompanied with patent foramen ovale and atrial fibrillation. This rare combination was detected during diagnostics for a cardiac etiology stroke. The left coronary sinus of Valsalva was reconstructed using an autologous pericardial patch, the left atrial appendage closed, left atrial ablation performed with cooled radiofrequency and the patent foramen ovale sutured directly. The patient was dismissed on the 12th postoperative day after having an uncomplicated postoperative course.

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          Most cited references5

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          Unruptured aneurysm of the left sinus of valsalva causing coronary insufficiency: case report and review of the literature.

          Aneurysm of the left sinus of Valsalva is extremely rare. Compression of the left coronary artery by such an aneurysm is an unusual complication of this condition and can cause coronary insufficiency. We describe the case of a 75-year-old woman who had an isolated unruptured aneurysm of the left coronary sinus with intraluminal thrombus, which caused coronary artery compression. We performed successful surgical correction by closing the mouth of the aneurysm without aortic valve replacement or coronary artery bypass grafting. A review of the world medical literature revealed 19 cases of sinus of Valsalva aneurysms that hindered the coronary arterial flow. The previously published reports of this rare condition and its treatment are discussed herein.
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            A 32-year experience with surgical repair of sinus of valsalva aneurysms.

            Sinus of Valsalva (SoV) aneurysms are rare (0.15% to 1.5% CPB cases) and five times more frequent in Asians. Usually congenital, SoV aneurysms arise from the right or noncoronary sinus, are associated with other cardiac defects, and are repaired primarily or with a patch. Acquired SoV aneuryms develop secondary to infection or trauma. Here, we describe our 32-year experience with SoV aneurysm repair in a Western population. A retrospective review identified 22 patients who underwent SoV aneurysm repair between 1971 and 2003. Data is presented as mean +/- standard error (median). Dyspnea was the most common presenting symptom. Nineteen of 22 patients were ruptured at the time of operation; three were found incidentally. Fifteen patients had associated cardiac defects including ventricular septal defect (VSD) (6), aortic insufficiency (6), and coarctation (3). One patient, repaired primarily, required reoperation for recurrence. All other patients underwent patch repair. The operative survival was 95% (21/22). There were five known late deaths at 6.6 +/- 2.3 (5.7) years post-repair. Five and ten year survival rates were 84.9 +/- 11% and 59.4 +/- 17%, respectively. Observed differences in the sinus of origin, age at presentation, associated cardiac malformations, and mortality in our Western series versus previous Asian cohort studies likely reflect a racial disparity and higher prevalence of acquired versus congenital SoV aneurysms. We recommend a thorough search for a VSD in all cases and use of patch repair, regardless of size, to reduce risk of recurrence.
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              Unruptured sinus of Valsalva aneurysm presenting as acute coronary syndrome.

              Sinus of Valsalva aneurysm is an infrequent cardiac anomaly. In the United States, it accounts for only 0.15 to 1.5% of all cardiopulmonary bypass procedures. Sinus of Valsalva aneurysms can be acquired, secondary to infectious, degenerative or traumatic processes. This paper describes the case report of an 81-year-old woman, with an unruptured aneurysm of the right Valsalva sinus, who was admitted to the emergency department with a history of chest pain. After surgical repair of the sinus ofValsalva aneurysm, the prognosis is usually good, and the risk of recurrence is rare.
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                Author and article information

                Contributors
                Journal
                Respir Med Case Rep
                Respir Med Case Rep
                Respiratory Medicine Case Reports
                Elsevier
                2213-0071
                12 April 2017
                2017
                12 April 2017
                : 21
                : 105-107
                Affiliations
                [a ]Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, “Hof” Clinics, University of Erlangen, Hof, Germany
                [b ]Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Academic Educational Hospital, Heidelberg University and Mainz University, Kaiserslautern, Germany
                [c ]Pulmonary Department-Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
                [d ]Department of Cardiac Surgery, 401 General Military Hospital of Athens, Athens, Greece
                [e ]Department of Thoracic Surgery, “Attikon” University Hospital of Athens, Athens University Medical School, Athens, Greece
                [f ]First Department of Internal Medicine, 401 General Military Hospital of Athens, Athens, Greece
                [g ]Department of Cardiothoracic Surgery, Medical School, University of Patras, Patras, Greece
                [h ]Department of Anestisiology, Emergency Care Medicine and Intensive Care Medicine, Westpfalz Klinikum, Academic Educational Hospital, Heidelberg University and Mainz University, Kaiserslautern, Germany
                [i ]Medical Clinic I, ’’Fuerth’’ Hospital, University of Erlangen, Fuerth, Germany
                [j ]Department of Respiratory and Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
                [k ]Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece
                Author notes
                []Corresponding author. pzarog@ 123456hotmail.com
                Article
                S2213-0071(17)30111-9
                10.1016/j.rmcr.2017.04.011
                5397011
                a230b241-648f-454f-8bb2-e85ed3fbea8b
                © 2017 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 3 April 2017
                : 9 April 2017
                : 10 April 2017
                Categories
                Case Report

                sinus of valsalva aneurysm,aortic aneurysm,patent foramen ovale,atrial appendage thrombus,atrial fibrillation,cardiac etiology stroke

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