Ruptured Sinus of Valsalva Aneurysm: Use of Multimodality Imaging in Delineating Structure and Function

Sinus of Valsalva aneurysm is a rare defect that can present with fatal complications in case of rupture. Heart failure symptoms are common due to high fraction of the resultant shunt. Multimodality imaging and invasive hemodynamic assessment is essential for comprehensive evaluation of the defect and guiding surgical planning. We describe the case of a 40-year-old woman who presented with heart failure symptoms and was found to have ruptured sinus of Valsalva aneurysm on transthoracic echocardiogram. Cardiac computed tomography angiography further characterized the defect and the associated anomalies. Right heart catheterization assessed the hemodynamic significance of the left to right shunt. Intraoperative findings highlighted the associated congenital anomalies including supracristal ventricular septal defect. The use of intraoperative transesophageal echocardiography proved essential in detecting worsening of the right ventricular outflow track infundibular dynamic obstruction post repair thus delineating the importance of maintaining adequate cardiac preload. This case highlights a stepwise approach in the anatomical characterization of sinus of Valsalva aneurysm using multimodality imaging and the use of hemodynamic assessment and intraoperative imaging to guide surgical planning.

Download Full-text

Right coronary sinus of Valsalva aneurysm evaluated by cardiac computed tomography angiography

Journal of Cardiovascular Computed Tomography ◽

10.1016/j.jcct.2008.02.014 ◽

2008 ◽

Vol 2 (3) ◽

pp. 193-194

Author(s):

Melissa Joines ◽

Bruce M. Barack ◽

Donald S. Chang

Keyword(s):

Computed Tomography ◽

Coronary Sinus ◽

Computed Tomography Angiography ◽

Cardiac Computed Tomography ◽

Sinus Of Valsalva ◽

Cardiac Computed Tomography Angiography ◽

Sinus Of Valsalva Aneurysm

Download Full-text

310 Ruptured sinus of Valsalva aneurysm as a rare cause of sisto-diastolic murmur: role of multimodality imaging in diagnosis and surgical planning

European Heart Journal Supplements ◽

10.1093/eurheartj/suab132.038 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Antonio De Luca ◽

Alessandro Fiocco ◽

Luca Restivo ◽

Angela Poletti ◽

Giorgio Faganello ◽

...

Keyword(s):

Aortic Valve ◽

Right Atrium ◽

Surgical Planning ◽

Multimodality Imaging ◽

Incidental Finding ◽

Elastic Fiber ◽

Sinus Of Valsalva ◽

Sinus Of Valsalva Aneurysm ◽

Diastolic Murmur ◽

The Right

Abstract A 27-year-old man had an incidental finding of sisto-diastolic murmur during a screening medical evaluation. Transthoracic and subsequent transesophageal echocardiography revealed a saccular enlargement of non-coronary (NC) sinus of Valsalva. The aneurysm extended into the right atrium (RA) and presented a large wall discontinuity, with continuous sisto-diastolic flow from the aorta to the right atrium. Computed tomography confirmed the findings and excluded other associated abnormalities. The patient underwent urgent surgical intervention. Intraoperatively, findings reported a floppy and cribrose saccular aneurysm sprouting from the NC sinus inside the RA. The correction turned out to be very challenging due to the close connection between the aneurysmal wall and the tricuspid valve (TV) and aortic valve (AV) annuli. The aortic NC sinus was excised and replaced with a Dacron patch. Damaging of the TV septal leaflet required repair through a consolidating suture involving the septal leaflet of TV and the corresponding annular insertion. AV replacement was also needed due to damage of the AV NC cusp. No complications occurred during the postoperative stay. Histopathology revealed severe atrophy of muscular and elastic fibres of the aortic wall, elastic fiber fragmentation, replacement fibrosis and extensive deposition of mucopolysaccharides. Sinus of Valsalva aneurysm (SoVA) is a rare condition characterized by an enlargement of the aortic root between the aortic valve and the sinotubular junction. SoVA can be either congenital, as a consequence of weakness of the elastic lamina, or acquired, due to infective, degenerative, or traumatic conditions. A prevalence of 0.09% was described in autopsy series and males are more frequently affected. Acute rupture of SoVA requires emergent surgery because of acute life-threatening haemodynamic instability. Congenital and chronic ruptured SoVA could be asymptomatic. Nevertheless, such incidental finding requires urgent surgical correction due to the possibility of unexpected further rupture, generating massive left-right shunt. The close relationship with nearby anatomical structures is a major issue which should be taken into account. In this perspective multimodality imaging is of paramount importance, allowing for a fine surgical planning and avoidance of complications.

Download Full-text

1210: Ruptured Congenital Sinus of Valsalva Aneurysm Complicated with Congestive Heart Failure in Real-Time Echocardiography

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2009.06.594 ◽

2009 ◽

Vol 35 (8) ◽

pp. S156

Author(s):

Fu-Chung Chen ◽

Shu-Man Cheng

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Real Time ◽

Sinus Of Valsalva ◽

Sinus Of Valsalva Aneurysm

Download Full-text

Abstract 14851: Under Pressure: Hemodynamics Bringing the Right "fix" to Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.14851 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Estefania Oliveros ◽

Ashish A Correa ◽

Aditya Parikh ◽

Robert Leber ◽

Soheila Talebi ◽

...

Keyword(s):

Heart Failure ◽

Troponin I ◽

Heart Sound ◽

Venous Pressure ◽

Heart Catheterization ◽

Av Fistula ◽

Flow Reserve ◽

Hemodynamic Assessment ◽

The Right ◽

High Output

Introduction: High-output heart failure (HF) develops in the setting of excessive cardiac output. Case Presentation: 65-year-old male with HF (EF 40%), severe right ventricular dysfunction, and emphysema presented with dyspnea and anasarca. On admission, physical examination showed a BP 97/66mmHg, heart rate 109bpm, temperature 97.2F, respiratory rate of 19rpm, 93% on 2-Liters of oxygen. Jugular venous pressure was 20 cm H20 with large V waves. The rhythm was irregular, with a loud second heart sound, audible third heart sound, parasternal heave, and left lower sternal border murmur. Lung exam demonstrated basilar crackles and prolonged expiratory phase. The abdomen was distended with a pulsatile liver and the lower extremities were cool with 3+ pitting edema. There was an audible bruit with thrill at the right groin. Laboratory testing showed sodium=123mEq/L, creatinine=1.25mg/dL, bilirubin=2.2, ALT=135U/L, AST=146u/L, troponin-I=0.097ng/mL, BNP=1528pg/mL. CT and VQ scan were negative for acute/chronic pulmonary embolism. Lower extremity Doppler ultrasound revealed a right common femoral arteriovenous (AV) fistula (Fig.1). After diuretics and milrinone, a left heart catheterization demonstrated known three vessel disease, but without limitations in instant flow reserve. Right heart catheterization demonstrated RA=15mmHg, RV=50/16mmHg, PA=50/24(34)mmHg, PCWP=11mmHg, CO=5.4L/min, PVR=4.25WU, after which the fistula was ligated. On post-op day 2, repeat hemodynamics off inotropes showed an RA=4mmHg, PA=40/18mmHg, PCWP=18 mmHg, CO=4.4L/min and normalization of end-organ function. He was maximized on GDMT. Echocardiogram 5 months later showed improvement of RV function and he was able to go back to work with minimal symptoms. Conclusion: AV fistulas can lead to high-output HF if undiagnosed. A multidisciplinary approach and comprehensive hemodynamic assessment proved essential in allowing improvement of symptoms and resulting outcomes.

Download Full-text

Surgical Rescue After Failed Percutaneous Closure of an Aorto-Atrial Tunnel

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118802802 ◽

2019 ◽

Vol 11 (4) ◽

pp. NP232-NP234

Author(s):

Federica Caldaroni ◽

Mauro Lo Rito ◽

Antonio Saracino ◽

Alessandro Varrica ◽

Luca Giugno ◽

...

Keyword(s):

Heart Failure ◽

Surgical Intervention ◽

Right Atrial ◽

Valve Regurgitation ◽

Aortic Valve Regurgitation ◽

Sinus Of Valsalva ◽

Sinus Of Valsalva Aneurysm ◽

The Right ◽

Indication For Treatment ◽

New Onset

Congenital sinus of Valsalva aneurysm is a rare disorder, mostly involving the right and noncoronary sinuses, in which intracardiac rupture is more likely foreseen into the right chambers. Because of the unfavorable prognosis, which includes heart failure and sudden death, detection itself is an indication for treatment, which may be performed either surgically or percutaneously. We present a case of a four-year-old patient with aorto-right atrial tunnel, in which a transcatheter attempt of closure was performed, complicated by new onset of aortic valve regurgitation, requiring surgical intervention.

Download Full-text

Giant Unruptured Sinus of Valsalva Aneurysm: An Unusual Cause of Right Heart Failure

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.170733 ◽

2015 ◽

Vol 5 ◽

pp. 64 ◽

Cited By ~ 3

Author(s):

Tejeshwar Singh Jugpal ◽

Rashmi Dixit ◽

Samta Lohchab ◽

Anju Garg

Keyword(s):

Heart Failure ◽

Right Ventricular Outflow Tract ◽

Right Heart Failure ◽

Ventricular Outflow Tract ◽

Unruptured Aneurysm ◽

Outflow Tract ◽

Sinus Of Valsalva ◽

Right Heart ◽

Sinus Of Valsalva Aneurysm ◽

The Right

Aneurysm of sinus of Valsalva is a rare cardiac abnormality. Unruptured aneurysm of sinus of Valsalva is usually asymptomatic and often discovered incidentally. However, a large aneurysm can, in rare cases, cause compression of the ventricular outflow tract. We report a case of 17-year-old male with congestive right heart failure with a large, partially thrombosed unruptured aneurysm of the right sinus of Valsalva. The aneurysmal sac was compressing the right ventricular outflow tract causing marked dilatation of the right ventricle and atrium that was confirmed on contrast-enhanced computed tomography imaging. Unruptured sinus of Valsalva aneurysm causing right heart failure in adolescence has been rarely reported in literature.

Download Full-text

Multimodality Imaging and 3D Modeling in Cardiac Surgical Planning: A Case of Infant with Isolated Left Atrial Appendage Aneurysm

Journal of Pediatrics & Neonatal Biology ◽

10.33140/jpnb.05.02.03 ◽

2020 ◽

Vol 5 (2) ◽

Keyword(s):

Left Atrial ◽

Surgical Planning ◽

Left Atrial Appendage ◽

Multimodality Imaging ◽

Cardiac Computed Tomography ◽

Atrial Appendage ◽

Rapid Progression ◽

3D Print ◽

Procedural Planning ◽

Left Atrial Appendage Aneurysm

We present here a case of an infant who was prenatally diagnosed with an isolated left atrial appendage aneurysm. Although asymptomatic, we proceeded with surgical resection due to rapid progression of aneurysm size. Multimodality imaging – transthoracic echocardiography, transesophageal echocardiography, and cardiac computed tomography – was used for procedural planning, from which a detailed 3D computational model and 3D print of this patient’s heart were created. The aneurysmectomy was performed at 6 months of age, with an uneventful postoperative course.

Download Full-text

Cardiogenic shock in the context of newly diagnosed anomalous origin of the right coronary artery originating from the pulmonary artery: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab030 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Coralea Kappel ◽

Justin Chow ◽

Zeeshan Ahmed ◽

Jon-David Schwalm ◽

Faizan Amin

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Cardiogenic Shock ◽

Right Coronary Artery ◽

Congenital Heart ◽

Cardiac Computed Tomography ◽

Obstructive Coronary Artery Disease ◽

Heart Catheterization ◽

Cardiac Computed Tomography Angiography ◽

Multiple Imaging

Abstract Background Anomalous right coronary artery (RCA) from the pulmonary artery (ARCAPA) is a rare congenital heart abnormality with varying clinical presentations, for which multiple imaging modalities are often required for diagnosis. Case summary We present a case of a 76-year-old female presenting with 2 weeks of palpitations and shortness of breath who was found to be in rapid atrial fibrillation (AF) with congestive heart failure. Despite initial medical management, the patient developed cardiogenic shock with anuric renal failure. Emergent right and left heart catheterization did not demonstrate any significant obstructive coronary artery disease but showed severe right ventricular (RV) failure and raised the possibility of an ARCAPA. This diagnosis was further corroborated by findings on a subsequent transoesophageal echocardiogram. In view of profound decline and limited anticipated improvement, the patient ultimately decided to pursue comfort measures in a hospice setting. Discussion We postulate that the underlying aetiology of our patient’s shock state was multifactorial, notably progressive RCA-territory ischaemia and RV failure, sepsis, and new-onset uncontrolled AF. In adults, unrecognized congenital heart disease can uncommonly cause cardiogenic shock. In our case, echocardiography and invasive angiography were integrated for the diagnosis of ARCAPA given the clinical circumstances that limited the use of cardiac computed tomography angiography.

Download Full-text