Rupture of sinus of Valsalva aneurysm to the right atrium resolved with interventionism.

We present a case of a ruptured right sinus of Valsalva aneurysm to the right atrium that developed global heart failure over the course of three months, and which was completely resolved through cardiac catheterism, placing an occlusive device at the site of the fistula. Its ethology is discussed, as well as the guidelines for clinical diagnosis and treatment.

Se presenta un caso de aneurisma del seno de Valsalva derecho roto a la aurícula derecha, que en el transcurso de tres meses desarrolló insuficiencia cardiaca global y fue resuelto del todo por medio de intervencionismo, colocando un dispositivo oclusor en el sitio de la fístula. Se discute su etología, así como las pautas para el diagnóstico clínico y el tratamiento.

Quadricuspid Aortic Valve with Ruptured Sinus of Valsalva Aneurysm: a Case Report.

Quadricuspid aortic valve (QAV) and sinus of Valsalva aneurysm (SVA) are rare congenital anomalies. We report an elderly patient with QAV associated with a ruptured SVA to the right atrium. Transthoracic echocardiographic and computed tomographic images are presented. We emphasize the important role of computed tomography angiography in establishing and confirming the diagnosis and facilitating treatment planning. The patient was successfully operated by a minimally invasive approach.

Acute Type A Aortic Dissection and Late Pregnancy: What Should We Do?

INTRODUCTION: Acute type A aortic dissection (AAAD) in late pregnancy is a rare but severe disease. Lack of clinical experience is the main cause of high mortality. This study tries to investigate the multidisciplinary therapeutic strategy for these patients. CASE PRESENTATION: We reported three patients with AAAD in late pregnancy. Sudden chest pain was the main clinical symptom before operation. All three patients and their newborns survived through multidisciplinary approach in diagnosis and treatment. No serious complications occurred during the mid-term follow-up. CONCLUSION: Multidisciplinary diagnosis and treatment strategy play a crucial role in saving the lives of pregnant women with AAAD.

[Massive aortic regurgitation with giant aorta aneurysm in Marfan syndrome] / Insuficiencia aórtica masiva con aneurisma de aorta gigante en síndrome de Marfan.

Marfan syndrome is an autosomal dominant hereditary disease that compromises various systems that usually require a multidisciplinary approach. The cause of Marfan syndrome is unknown, but recent genetic studies have related this disease to an extracellular microfibrillar defect located on chromosome 15q15-q21.3. Due to the severity of the signs and symptoms the diagnosis is usually at a very young age. We report a patient with extreme Marfan syndrome with all the particulars that this syndrome offers.

El síndrome de Marfan es una enfermedad hereditaria autosómica dominante que compromete diversos sistemas que habitualmente requieren un enfoque multidisciplinario. La causa del síndrome de Marfan es desconocida, pero recientes estudios genéticos han relacionado esta enfermedad a un defecto microfibrilar extracelular localizado en el cromosoma 15q15-q21,3. Debido a la severidad de los signos y síntomas el diagnóstico suele ser a edad muy temprana. Reportamos un paciente con síndrome de Marfan extremo con todas las particulares que éste síndrome ofrece.

Aneurisma de seno de valsalva fistulizado a auricula derecha / Fístula of sinus of valsalva aneurysm to the right atrium

Resumen: Los aneurismas de seno de Valsalva son una malformación rara de observar en la práctica clínica. Se presentan a cualquier edad y pueden ser de origen congénito o adquirido. La importancia de su estudio radica en que potencialmente pueden complicarse con rotura y fistulización a otra estructura cardíaca o extracardíaca, con una alta mortalidad asociada. El diagnóstico muchas veces puede ser complejo, pero existen algunos elementos clínicos inespecíficos que pueden orientarnos en su detección y rápido manejo, lo que puede marcar una diferencia en el pronóstico del paciente. Se presenta el caso de un paciente de 49 años con un aneurisma de seno de Valsalva complicado y a continuación una breve revisión del tema.

Abstract: Aneurysms of the sinus of Valsalva are. They occur at any age, either as a congenital or an acquired malformation. They may rupture and form a fístula to other cardiac structures, with a high mortality rate. The clinical case of a 49 year-old patient with a ruptured sinus of Valsalva an a fístula to the right atrium is presented. A brief review of the subject is included.

Tuberculous Aortic Aneurysm - A Review.

INTRODUCTION: Tuberculous aortic aneurysm (TBAA) is an exceedingly rare but severe manifestation of tuberculosis, with a high risk of sudden rupture of the aorta in absence of medical or surgical intervention. This review aimed to provide a detailed understanding of TBAA, including its associated complications, affected population, treatment measures, and outcomes. METHODS: Case studies and relevant research articles were analyzed to understand the recent advances in medical scientific knowledge on TBAA. Recent clinical case reports on TBAA were searched from the year 2010 to 2020. RESULTS: Case reports indicated a higher prevalence of TBAA in the male population. The most affected age group was 15 to 79 years. The most common treatment for TBAA included surgery followed by antituberculous medication. The case reports discussed in this review reflected open surgery, endovascular repair, coil embolization, laparotomy, aortic valve and root replacement as some of the surgical procedures used depending on the complication and type of aneurysm. The treatment outcome was considered effective in most cases. CONCLUSION: Postoperative chemotherapy and medications reduce the risk of severity. Early diagnosis of TBAA is imperative, followed by surgical resection and postoperative antituberculous medication with careful follow-up to prevent relapse.

Early and late-term follow-up results of patients diagnosed with aortic aneurysm or aortic dissection with aortic regurgitation undergoing aortic valve repair or valve-sparing aortic surgery

Abstract Introduction: Valve-reimplantation and remodelling techniques used in aortic reconstruction provide successful early, mid, and long-term results. We present our early and late-term experience with 110 patients with aortic regurgitation (AR) who underwent aortic valve repair (AVr) or valve-sparing aortic root surgeries (VSARS) due to aortic dissection or aortic aneurysm. Methods: Nine hundred eighty-two patients who underwent aneurysm or dissection surgery and aortic valve surgery between April 1997 and January 2017 were analysed using the patient database. A total of 110 patients with AR who underwent AVr or VSARS due to aortic dissection or aortic aneurysm were included in the study. Results: In the postoperative period, a decrease was observed in AR compared to the preoperative period (P<0.001); there was an increase in postoperative ejection fraction (EF) compared to the preoperative values (P<0.005) and a significant decrease in postoperative left ventricle diameters compared to the preoperative values (P<0.001). Kaplan-Meier analysis revealed one, two, four, and five-year freedom from moderate-severe AR as 95%, 91%, 87%, and 70%, respectively. Freedom from reoperation in one, two, and five years were 97.9%, 93.6%, and 81%, respectively. Eight patients (7.4%) underwent AVr during follow-up. Out of the remaining 100 patients, 13 (12%) had minimum AR, 52 (48%) had 1st-2nd degree AR, and 35 (32%) had 2nd-3rd degree AR during follow-up. Conclusion: For the purpose of maintaining the native valve tissue, preserving the EF and the left ventricular end-diastolic diameter, valve-sparing surgeries should be preferred for appropriate patients.

Early and Late-Term Follow-Up Results of Patients Diagnosed with Aortic Aneurysm or Aortic Dissection with Aortic Regurgitation Undergoing Aortic Valve Repair or Valve-Sparing Aortic Surgery.

INTRODUCTION: Valve-reimplantation and remodelling techniques used in aortic reconstruction provide successful early, mid, and long-term results. We present our early and late-term experience with 110 patients with aortic regurgitation (AR) who underwent aortic valve repair (AVr) or valve-sparing aortic root surgeries (VSARS) due to aortic dissection or aortic aneurysm. METHODS: Nine hundred eighty-two patients who underwent aneurysm or dissection surgery and aortic valve surgery between April 1997 and January 2017 were analysed using the patient database. A total of 110 patients with AR who underwent AVr or VSARS due to aortic dissection or aortic aneurysm were included in the study. RESULTS: In the postoperative period, a decrease was observed in AR compared to the preoperative period (P<0.001); there was an increase in postoperative ejection fraction (EF) compared to the preoperative values (P<0.005) and a significant decrease in postoperative left ventricle diameters compared to the preoperative values (P<0.001). Kaplan-Meier analysis revealed one, two, four, and five-year freedom from moderate-severe AR as 95%, 91%, 87%, and 70%, respectively. Freedom from reoperation in one, two, and five years were 97.9%, 93.6%, and 81%, respectively. Eight patients (7.4%) underwent AVr during follow-up. Out of the remaining 100 patients, 13 (12%) had minimum AR, 52 (48%) had 1st-2nd degree AR, and 35 (32%) had 2nd-3rd degree AR during follow-up. CONCLUSION: For the purpose of maintaining the native valve tissue, preserving the EF and the left ventricular end-diastolic diameter, valve-sparing surgeries should be preferred for appropriate patients.

Tratamento endovascular de aneurisma sacular aórtico associado à doença de Adamantiades-Behçet / Endovascular treatment of aortic saccular aneurysms associated with Adamantiades-Behçet disease

Resumo A doença de Adamantiades-Behçet é uma desordem multissistêmica que se apresenta classicamente com úlceras orais e genitais e envolvimento ocular, podendo o acometimento vascular ocorrer em até 38% dos casos. O envolvimento aórtico é uma das manifestações mais severas e está associado a altas taxas de mortalidade, ocorrendo em 1,5 a 2,7% dos casos. Relatamos um caso de aneurisma sacular de aorta abdominal em um paciente de 49 anos com doença de Adamantiades-Behçet complicada, tratada por correção endovascular.

Abstract Adamantiades-Behçet disease is a multisystemic disorder that classically presents with oral and genital ulcers and ocular involvement, with vascular involvement in up to 38% of cases. Aortic involvement is one of the most serious manifestations and is associated with high mortality rates, occurring in 1.5 to 2.7% of cases. We report a case of a saccular abdominal aorta aneurysm in a 49-year-old male patient with complicated Adamantiades-Behçet disease that was treated with endovascular repair.

Hoarseness Due to Aortic Arch Aneurysms.

OBJECTIVE: To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm. METHODS: By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own. RESULTS: The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients. CONCLUSION: The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.

Hoarseness due to aortic arch aneurysms

Abstract Objective: To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm. Methods: By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own. Results: The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients. Conclusion: The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.

The Largest Reported Giant Ascending Aortic Aneurysm Presented with Superior Vena Cava Syndrome.

Giant ascending aortic aneurysm is a rare condition. In this paper, we present an uncommon case of giant ascending aortic aneurysm with a maximal diameter of 14 cm in a 77-year-old woman presenting with unusual symptoms. The patient underwent a successful surgery involving ascending aortic replacement, and was discharged without any complication. After discharge, she was followed regularly and no major problem was observed in her control visits. To the best of our knowledge, our case is the largest ascending aortic aneurysm reported to date in the existing literature.

The largest reported giant ascending aortic aneurysm presented with superior vena cava syndrome

Abstract Giant ascending aortic aneurysm is a rare condition. In this paper, we present an uncommon case of giant ascending aortic aneurysm with a maximal diameter of 14 cm in a 77-year-old woman presenting with unusual symptoms. The patient underwent a successful surgery involving ascending aortic replacement, and was discharged without any complication. After discharge, she was followed regularly and no major problem was observed in her control visits. To the best of our knowledge, our case is the largest ascending aortic aneurysm reported to date in the existing literature.

Surgical Management of Left Sinus of Valsalva Aneurysm Presenting with Exertional Chest Pain.

Left sinus of Valsalva aneurysm (SVA) is a very infrequent clinical entity. Valsalva aneurysms are often asymptomatic in right and non-coronary sinuses and the diagnosis is often incidental. A left SVA which presents with exertional chest pain due to compression of left coronary system arteries is extremely rare. In this case, we present a successful surgical repair of left SVA without aortic regurgitation or myocardial infarction in a 59-year-old male patient.

Surgical management of left sinus of valsalva aneurysm presenting with exertional chest pain

Abstract Left sinus of Valsalva aneurysm (SVA) is a very infrequent clinical entity. Valsalva aneurysms are often asymptomatic in right and non-coronary sinuses and the diagnosis is often incidental. A left SVA which presents with exertional chest pain due to compression of left coronary system arteries is extremely rare. In this case, we present a successful surgical repair of left SVA without aortic regurgitation or myocardial infarction in a 59-year-old male patient.

Aortic Aneurysm as a Cause of Dysphonia in a Patient Who Smokes.

Vocal cord paralysis secondary to a cardiovascular disease is known as Cardiovocal or Ortner's syndrome. The most common cause of Ortner's syndrome is atrial dilation due to mitral valvulopathy. Other causes include aneurysms of the thoracic aorta, patent ductus arteriosus, aneurysm of the ductus arteriosus, defects of the interatrial or interventricular septum, among others. Hoarseness might be the only symptom that leads a given individual to consult with a physician. Here we present the case of a 77-year-old male patient with history of diabetes mellitus type 1 and hypertension, whose illness started about a year ago when he presented progressive dysphonia associated with dry cough after food intake without another concomitant symptom. CT studies reported the presence of an aortic aneurism compressing the left recurrent nerve. Patient refused surgical treatment. As of this writing, he remains symptomatic.

Complete atrioventricular block as an initial manifestation of aortic dissection: A case report.

The right coronary artery involvement occurs in 1-2% of aortic dissection and may cause atrioventricular (AV) block due to obstruction of blood supply to the AV node. A 59-year-old man with a history of hypertension presented to the emergency department with chest pain and complete AV block. After the diagnostic approach, aortic dissection Stanford A was diagnosed. Aortic dissection must be suspected in hypertensive patients who present with AV block and chest pain.

La obstrucción de la coronaria derecha debida a extensión de disección aórtica ocurre en el 1 a 2% de los casos y puede ocasionar bloqueo auriculoventricular. En este caso se presenta a un paciente de 59 años con antecedente de hipertensión que acudió al servicio de urgencias por dolor precordial y bloqueo auriculoventricular completo. Tras el abordaje inicial se diagnosticó disección aórtica (Stanford A). Se debe sospechar la presencia de disección aórtica en pacientes con descontrol hipertensivo, bloqueo auriculoventricular completo y dolor torácico.