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Fulltext The surgical repair of ruptured sinus of valsalva aneurysms

Yap S, Jeyamalar R

Med J Malaysia, 1987 Sep;42(3):182-5.
PMID: 3506641

Over a period of nine years, from June 1976 through May 1985, 18 cases of ruptured sinus of Valsalva aneurysms were seen at the University Hospital, Kuala Lumpur (UK KL). Seven of these cases were treated surgically. The majority of patients were males, with a mean age of 26.6 years. All cases were symptomatic. The site of aneurysm was the right coronary sinus in five patients and the non-coronary sinus in two patients. All aneurysms ruptured into the right ventricle. The fistula was closed via a transaortic approach. In addition, repair of the right heart chamber was necessary in six patients. There were no deaths. Clinically significant morbidity included aortic regurgitation in one patient and residual fistula requiring reoperation in another. The long term follow-up at two years was excellent.

Matched MeSH terms: Sinus of Valsalva/surgery*
Fulltext Ruptured aneurysms of the sinus of Valsalva

Jeyamalar R, Kannan P

Med J Malaysia, 1991 Dec;46(4):371-5.
PMID: 1840448

Aneurysms of the sinus of Valsalva are uncommon disorders and are usually congenital in origin. When these aneurysms rupture into an intracardiac chamber, they may be silent initially but later give rise to progressive heart failure due to left or right shunting and aortic regurgitation. The mortality and morbidity in untreated cases is high. We report 13 patients with ruptured aneurysms of the sinus of Valsalva who underwent surgical repair. There were seven males and six females with a mean age of 24.5 years. Three patients were asymptomatic and five were in congestive cardiac failure. The majority of patients (61.5%) had insidious onset of symptoms, only 2 cases presenting acutely. The connection was between the right aortic sinus and the right ventricle in 11 cases and the non coronary sinus and the right ventricle in 2 cases. Associated cardiac anomalies included a ventricular septal defect (8 patients) and aortic regurgitation (6 patients). There was 1 post operative death and 1 patient required re-operation three months later for a recurrence of the fistula. All 6 patients with aortic regurgitation required aortic valve replacement. All patients remained well and asymptomatic during follow up ranging from 2 to 19 years.

Matched MeSH terms: Sinus of Valsalva*
Fulltext Independent origin of anterior interventricular and left marginal arteries from the left posterior aortic sinus

Shetty P, Nayak SB

Anat Cell Biol, 2019 Sep;52(3):340-343.
PMID: 31598365 DOI: 10.5115/acb.19.018

We present a unique, unreported variation of the left coronary artery. During dissection classes for first-year medical students, we observed the absence of left coronary artery in an adult male cadaver aged approximately 78 years. The left aortic sinus was dilated and it gave origin to anterior interventricular and left marginal arteries independently. Left marginal artery was large and the circumflex artery arose from it. There were two independent opening for anterior interventricular and left marginal arteries in the left posterior aortic sinus. No variations were found in the origin and branching pattern of right coronary artery and the walls and chambers of the heart.

Matched MeSH terms: Sinus of Valsalva
Fulltext A ten-year review of ruptured sinus of valsalva: clinico-pathological and echo-Doppler features

Shah RP, Ding ZP, Ng AS, Quek SS

Singapore Med J, 2001 Oct;42(10):473-6.
PMID: 11874151

Rupture of the sinus of valsalva (RSOV) is an uncommon condition with a variety of manifestations ranging from an asymptomatic murmur to cardiogenic shock. This retrospective 10-year review (1985-1995) of 18 patients from a single institution revealed that 6 (33%) were female and 12 (67%) were male with a mean age of 37.6 +/- 13.4 years and that 72% were Chinese by ethnic descent with the remaining 28% being Malay. Eight patients (44.4%) presented with an asymptomatic murmur, 4 (22.2%) with acute chest pain, 4 (22.2%) with mild heart failure, 2 (11.1%) with severe heart failure, and 2 (11.1%) with cardiogenic shock. Rupture of the right aneurysmal coronary cusp (RCC) made up 15 (83.3%) while those of the non-coronary cusp (NCC) made up the remaining. Most of the RCC ruptures were directed into the right ventricle and all of the NCC ruptures were into the right atrium. Ventricular septal defects (VSDs) were found in 9 (50%) of the patients, (although detected by echocardiography in only one third of those patients), aortic regurgitation in 6 (33.3%) and aortic valve vegetations in 2 (11.1%). Echocardiography was found to be accurate in diagnosing RSOVs with 100% diagnostic accuracy after 1990 with four misdiagnoses before 1990. Of these four patients, two were misdiagnosed as having VSDs, one as having a coronary arteriovenous fistula and one as having a patent ductus arteriosus. The anatomical structure of the "windsock" was seen in 64% of the patients who were correctly diagnosed. The pattern of colour flow and spectral Doppler was seen in all patients and helped to localise the site of rupture and the direction of flow. In summary, echocardiography is a simple and accurate way of diagnosing and defining RSOVs and is the imaging modality of choice.

Matched MeSH terms: Sinus of Valsalva*
Device closure of patent ductus arteriosus in Marfan patients: safety and effect on the aortic root diameter

Zanjani KS, Wong AR, Sadiq M, Weber HS, Cutler NG

Congenit Heart Dis, 2010 Sep-Oct;5(5):439-43.
PMID: 21087429 DOI: 10.1111/j.1747-0803.2010.00448.x

Objectives: There is little evidence in the medical literature about safety of PDA device closure and its effects on aortic root diameter in Marfan patients. We reported on nine Marfan patients whose ducts were occluded by coil or Amplatzer Duct Occluder.
Patients and interventions: Two patients had aneurismal type E ducts which were closed by a single coil, respectively. The others had conical ducts for which even Amplatzer occluder, stiff, or double coils were used.
Results: No untoward consequence was found during a median follow up period of 18.5 months (range 3 months to 6.33 years). Two patients had small residual shunts. The observed change in the mean ratio of aortic root diameter to its estimated value was statistically insignificant in seven patients who had complete data on their aortic root diameter before PDA closure and during the follow up.
Conclusions: We concluded that PDA device closure in Marfan patients is safe. Risk of residual shunt is higher even after closure of small ducts.

Matched MeSH terms: Sinus of Valsalva/ultrasonography*
Fulltext Ruptured sinus of Valsalva aneurysm with ventricular septal defect complicated by preoperative cardiogenic shock, cardiac arrest, and multiple organ dysfunction: a rare survivor and review of contemporary literature

Furui M, Dillon J, Akhtar KMA, Bin Ja'apar AN

J Surg Case Rep, 2020 Dec;2020(12):rjaa567.
PMID: 33425326 DOI: 10.1093/jscr/rjaa567

Sinus of Valsalva aneurysm (SVA) is a relatively rare cardiac condition, in which the patient is usually asymptomatic. However, once this aneurysm ruptures, patients present with acute symptoms of heart failure. Timely surgical intervention is essential. We present the case of a 27-year-old woman, who had a ruptured SVA with a ventricular septal defect (VSD). The patient collapsed before the emergency operation and needed cardiopulmonary resuscitation. The patient required preoperative high inotoropic support and postoperative management was difficult because of multiple organ dysfunction. However, the patient recovered after using inhaled nitric oxide and veno-venous hemofiltration and tracheostomy, and was discharged with no further complications. To the best of our knowledge, no such case of a ruptured SVA with VSD, complicated by preoperative cardiac arrest and multiple organ dysfunction that culminated in a successful recovery, has been reported to date.

Matched MeSH terms: Sinus of Valsalva
Fulltext A challenging case report of acute sinus of Valsalva aneurysm rupture in cardiogenic shock and multi-organ failure with an emphasis on rapid recognition and 'never giving up' in face of futility

Jin QW, Jeswant Dillon J, Tjen Jhung L, Isman Rusani B

Eur Heart J Case Rep, 2020 Dec;4(6):1-5.
PMID: 33442636 DOI: 10.1093/ehjcr/ytaa441

Background : Sinus of Valsalva aneurysm (SoVA) is a rare anomaly and can be divided into acquired and congenital forms, the latter being commonly associated with ventricular septal defects (VSDs). Rupture is a catastrophic complication with high mortality without urgent surgical intervention. We would like to highlight the use of echocardiography in an emergency setting for diagnosis and surgical intervention in a critically ill patient.
Case summary : We report a 27-year-old female with history of conservatively managed VSD known since childhood. She presented with acute decompensated cardiac failure requiring intubation and inotropic support. Bedside echocardiography performed in the emergency department suggested a ruptured SoVA at the right coronary cusp with underlying supracristal VSD. Despite the patient being critically ill with multi-organ failure, surgery was performed as it was the patient's best chance for survival. Intraoperative findings tallied with the early echocardiographic results. She recovered gradually and was eventually discharged despite a stormy post-operative period.
Discussion : This case report highlights the importance of prompt recognition of SoVA rupture by using bedside echocardiography. Surgical intervention needs to be early despite ongoing sepsis in view of acute mechanical failure. This case was unique as it illustrates a successful management of an acutely ill patient with multi-organ failure through early diagnosis, intensive perioperative stabilization, and surgical intervention.

Matched MeSH terms: Sinus of Valsalva