Surgical repair of a ruptured congenital sinus of Valsalva aneurysm: 10-year experience with 286 cases.

OBJECTIVES: Surgical intervention is the main treatment for a ruptured congenital sinus of Valsalva aneurysm (SVA). However, reports on the surgical experience are scarce. We retrospectively analysed the cases of our centre to summarize our 10-year experience. METHODS: A total of 286 patients who were diagnosed with a congenital ruptured SVA and underwent surgical repair between 2007 and 2016 were identified for the analysis. Follow-up data (mean ± standard deviation: 49.6 ± 34.9 months) were obtained from outpatient department records and telephone calls. RESULTS: The SVAs originated from the right coronary sinus (79.7%), the non-coronary sinus (19.6%) and the left coronary sinus (0.7%) but ruptured into the right ventricle (58.4%) and the right atrium (41.3%). The most commonly associated deformities were a ventricular septal defect (46.3%), aortic valve regurgitation (33.2%) and tricuspid regurgitation (20.3%). The SVA defect was closed by direct suturing (9.1%) or patching (90.9%) through an incision in the cardiac chamber involved or a transaortic approach. The mean postoperative hospital stay duration was 7.2 days, and 98.6% of the patients were discharged in New York Heart Association functional class I or II. The incidence rate of short-term complications was 5.7%. There were 4 late deaths, and 9 patients required rehospitalization due to surgery-related events. The estimated 10-year survival rate was greater than 90% according to the Kaplan-Meier survival curve. CONCLUSIONS: Surgical repair is an effective and safe treatment for a ruptured SVA. The majority of patients who undergo surgical repair can survive for a long time.

Giant Aneurysm of the Ascending Aorta Requiring Emergency Repair in a Newborn Baby.

Congenital aneurysm of the ascending aorta is a rare cardiovascular pathology and usually associated with well-known connective tissue disorders. We present an idiopathic ascending aortic aneurysm extending to the aortic arch in an antenatally diagnosed newborn who required immediate surgical treatment due to the rapid progression of aneurysm size at the age of 1 day.

Sinus of valsalva aneurysm rupturing into main pulmonary artery: A rare paediatric cardiac emergency.

Congenital Sinus of Valsalva aneurysm is a rare congenital cardiac disease. Most common site of origin is the right sinus. It ruptures into right ventricle or right atrium most of the times. Only in less than 2% of the cases it ruptures into the pulmonary artery. We report a rare case of right sinus of valsalva aneurysm rupturing into pulmonary artery.

Dissecting aneurysm of the interventricular septum due to rupture of the sinus of Valsalva.

Aneurysm of the sinus of Valsalva is a rare congenital cardiac anomaly. It occurs as an outpouching that progresses like a windsock, and it may rupture producing aortic regurgitation, cardiac tamponade, congestive heart failure, conduction abnormalities, and stroke. We describe a case of rupture of the sinus of Valsalva into the interventricular septum producing a large dissecting aneurysm. Despite the location, it did not produce a conduction abnormality.

Caso 10. Aneurisma de arteria subclavia derecha aberrante / Case 10. Aberrant right subclavian artery aneurysm

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Unruptured Sinus of Valsalva Aneurysm Obstructing the Left Ventricular Outflow Tract: An Uncommon Presentation in Childhood.

Congenital aneurysms of the sinus of Valsalva are uncommon abnormalities that are usually silent and slowly progressive without symptoms of cardiac dysfunction unless catastrophic rupture occurs. However, in rare cases, unruptured aneurysms can produce symptoms resulting from compression of adjacent structures, ventricular outflow tract obstruction, heart block, and coronary and valvular insufficiency. We report a case of a single unruptured sinus of Valsalva aneurysm producing left ventricular outflow tract obstruction in an 8-year-old boy who presented with chest pain on exertion.

Surgery for congenital diseases of the aorta.

Congenital diseases of the aorta tend to be obstructive when they present early in life, and aneurysmal when they present later in life. The latter group also tends to be associated with connective tissue disorders and with repaired conotruncal lesions. The indications for intervention in the aneurysm group are still in evolution but are clearly age- and lesion-dependant. Disorders such as Loeys-Dietz syndrome and Turner syndrome may deserve aggressive prophylactic surgery, as well as Marfan syndrome to a lesser extent. The natural history of the dilated aorta after repair of congenital heart lesions is probably more benign than de novo aneurysms and therefore should be treated conservatively.

Multiple ruptures of left sinus of Valsalva aneurysm into main pulmonary artery.

Sinus of Valsalva aneurysm is a rare congenital glitch. We report an extremely rare case of left sinus of Valsalva aneurysm compressing and rupturing into the main pulmonary artery with 2 communications. The 34-year-old man also had severe aortic regurgitation and severe tricuspid regurgitation. He underwent successful polytetrafluoroethylene patch repair and aortic valve replacement. The rarity of this case highlights the need for a precise preoperative diagnosis, the roles of transthoracic echocardiography, transesophageal echocardiography, and 3-dimensional echocardiography, and the importance of prompt surgical management.

Case of congenital aneurysm of sinus of Valsalva with common arterial trunk.

We describe an unusual case of a patient with common arterial trunk and interrupted aortic arch, complicated by congenital aneurysm of the sinus of Valsalva, who underwent successful repair. To our knowledge, no such case has been reported in the English literature. The combination of common arterial trunk and congenital aneurysm of the sinus of Valsalva may yield insights into the morphogenesis of congenital aneurysm of the sinus of Valsalva.

Ruptured sinus of Valsalva found incidentally in a patient with tetralogy of Fallot.

Ruptured sinus Valsalva aneurysm (SVA) in a patient with tetralogy of Fallot is a very rare cardiac complication. This report describes the case of a 10-year-old Hispanic girl who presented to her cardiologist for a routine transthoracic echocardiography (TTE), which showed a ruptured sinus of Valsalva, with left-to-right shunting noted from the right cusp to the right ventricular outflow tract and pulmonic insufficiency. The patient underwent right and left heart catheterization with transesophageal echocardiography guidance and closure of the ruptured sinus of Valsalva with an Amplatzer muscular ventricular septal defect (VSD) device. Later that day, after the procedure, it was noted that the patient had a recurrence of continuous murmur. The TTE did not visualize the Amplatzer VSD device, and chest X-ray showed that the device had embolized to the right pulmonary artery. The device was successfully retrieved percutaneously. The patient returned 2 weeks later for surgical repair of a ruptured SVA and pulmonary valve replacement, which went well. This case report is the first to describe congenital rupture of a Valsalva aneurysm in a patient with tetralogy of Fallot. The conventional treatment for a ruptured sinus of Valsalva is surgical, although transcatheter approaches have been used increasingly in recent years.

Rupture of sinus of Valsalva aneurysm with aorto-biventricular fistulas and right-ventricular outflow tract obstruction: a unique association.

Sinus of Valsalva aneurysms are a rare entity. Rupture of such aneurysms is a major cause of aortocardiac fistulas usually occurring between the right sinus of Valsalva and right cardiac chambers. We report an exceptional case of a ruptured congenital sinus of Valsalva aneurysm with fistulas involving both the right- and left-ventricular outflow tracts and causing RVOT obstruction. We also demonstrate the utility of computed tomography angiography and transesophageal echocardiography in diagnosing these fistulas.

Congenital rock and a hard place: unicuspid aortic valve with sinus of valsalva aneurysm.

Cardiac CT angiography (CTA) is an ideal tool to investigate possible cardiac malformations. In this case, careful planning of the CTA acquisition and reconstruction provided high resolution images of cardiac anatomy revealing 2 extremely rare coexisting congenital defects; a unicuspid aortic valve (UAV) and sinus of Valsalva aneurysm (SVA). Detailed planning of CTA acquisition reconstruction protocols is essential in obtaining necessary information for clinical decision-making strategies and interventions in the patients with suspected cardiac anomalies.

Incidental detection of a giant ductus arteriosus aneurysm by low-dose multidetector computed tomography in an asymptomatic adult.

Aneurysm of the ductus arteriosus is a very rare congenital lesion in adults that can be associated with thromboembolism, rupture, and death. Its detection in a silent clinical phase is very important for planning appropriate treatment and avoiding potentially fatal complications. We report a case of a patent ductus arteriosus aneurysm of very large size (65.5 mm) that was incidentally discovered with low-dose (3.2 mSv) multidetector computed tomography in an asymptomatic 67-year-old man. The presence of coronary disease was also ruled out with this non-invasive imaging modality. Further evaluation with echocardiography and selective angiography confirmed the diagnosis. At surgery, the aneurysm was successfully resected via a left posterolateral thoracotomy.

Giant congenital aortic aneurysm with cleft sternum in a neonate: pathological and surgical considerations for optimal management.

We report a rare case of a neonate with congenital giant aortic aneurysm associated to cleft sternum, who underwent surgical repair. The patient died on postoperative Day 5 from cardiac arrest. Autopsy revealed a circumferential subendocardial myocardial infarction and misdiagnosed coronary ostial anomalies. A critical analysis of this unfortunate case may help optimal surgical planning in similar patients in the future.

Surgical repair of a sinus of a Valsalva aneurysm ruptured into the left ventricle.

A 47-year-old man presented with orthopnea. He had no infection or, in particular, infectious endocarditis. An echocardiogram and multislice computed tomography scan revealed a left sinus of Valsalva aneurysm (SVA) that had ruptured into the left ventricle, with severe aortic regurgitation. He was diagnosed with ruptured congenital SVA with severe aortic regurgitation and underwent closure of the aneurysmal mouth with a Dacron patch, and concomitant aortic valve replacement. The use of a Dacron patch to close the aneurysmal mouth of a ruptured congenital left SVA has not been reported previously in the medical literature.

Surgical repair of multiple unruptured aneurysms of sinus of Valsalva.

Unruptured aneurysm of sinus of Valsalva (ASV) is a rare congenital anomaly. We describe a case of multiple unruptured ASV involving right and left aortic sinuses causing congestive cardiac failure in a 16-year-old boy who underwent successful surgical repair.

Unruptured congenital aneurysm of the sinus of Valsalva in an African population: a six-year experience at an echocardiography laboratory.

Sinus of Valsalva aneurysms (SVA) are considered rare congenital anomalies. Apart from a few reported cases of SVA in African patients, there is little information on the clinical presentation of this entity in Africans. We describe the clinical and echocardiographic features of four consecutive African patients in whom the diagnosis of SVA was established over the last six years at the echocardiography laboratory of our institution. In this report we compare the clinical and echocardiographic features in our patients with those of others published in the literature.

Congenital aortic sinus aneurysm causing sudden unexpected death in a 56-year-old woman.

Sudden unexpected death due to hemopericardium generally has 2 main causes, rupture of the ascending aorta or rupture of a transmural myocardial infarct. We report an unusual cause of fatal hemopericardium in a 56-year-old woman that occurred in the setting of a motor vehicle mishap.At autopsy, 300 mL of blood were present in the pericardial sac, due to rupture of a previously undetected congenital aortic sinus aneurysm. The low velocity of the automobile at the time of impact with a fence, and the absence of vehicle-related trauma, led to the conclusion that rupture of the aneurysm caused the motor vehicle mishap, rather than vice versa. Because of the typically silent nature of such aneurysms, it is likely that their rupture will occur out-of-hospital and require a forensic investigation.