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

Gürbüz, Ali; İşcan, Şahin; Gokalp, Orhan; Karaagac, Erturk; Girgin, Senem; Aksun, Murat

doi:10.21470/1678-9741-2019-0437

Cited by 2 publications

(1 citation statement)

References 8 publications

(13 reference statements)

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“… 8 Only a handful of case reports have reported on myocardial ischaemia as a complication of left SVAs. 9 There is a higher risk of myocardial ischaemia in left than right SVAs, possibly due to the central part of the left atrial coronary sinus being directly exposed to the pericardium. 10 …”

Section: Discussionmentioning

confidence: 99%

Giant left sinus of Valsalva aneurysm as a rare cause of acute myocardial infarction: a case report

Maqableh,

Yuan,

Moody

et al. 2024

European Heart Journal - Case Reports

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Background Sinuses of Valsalva Aneurysm (SVA) is a rare but potentially life-threatening condition. Acute myocardial infarction (MI) is a rare consequence of aneurysmal dilatation of one or more sinuses of Valsalva. We present a case of an unruptured and partially thrombosed left SVA, presenting as anterior MI and congestive heart failure. Case Summery A 55-year-old gentleman was admitted with pulmonary oedema and a late presenting ST elevation MI with Q wave. After initial treatment on furosemide infusion, a coronary angiography showed significant stenosis in both his left main stem (LMS) and left anterior descending artery (LAD). This is likely a result of external compression, potentially from the enlarged left sinus of Valsalva. A subsequent transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TOE) confirmed large SVA involving the left coronary cusp measured 9.9 cm compressing both LMS and LAD. Discussion Left SVAs are rare and frequently asymptomatic, typically being identified incidentally. Due to close proximity of the left coronary system, they can present with myocardial ischemia due to extrinsic compression of coronary system. We were able to perform a comprehensive multimodality assessment of left SVA which helped establish this unusual diagnosis and guide management. TTE & TOE helped assess the SVA and demonstrated the thrombus in situ, aortic valve insufficiency and the cardiac function. The computed tomography scan (CT) aided in accurately defining the extent of the aneurysm and the extent of compression of left coronary system and cardiac magnetic resonance scan (CMR) was able to demonstrate viability in LAD and CX territory.

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Section: Discussionmentioning

confidence: 99%

Giant left sinus of Valsalva aneurysm as a rare cause of acute myocardial infarction: a case report

Maqableh,

Yuan,

Moody

et al. 2024

European Heart Journal - Case Reports

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A rare variant of a ruptured sinus of valsalva aneurysm forming an aorto-atrial fistula: a case report and review of literature

Dayco

Dsouza

Baciewicz

et al. 2023

European Heart Journal - Case Reports

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Background Sinus of Valsalva aneurysms (SOVAs) are infrequent findings and generally diagnosed incidentally. A SOVA may be at risk for rupture, which would lead to an aorto-cardiac shunt. These patients present similarly to decompensated heart failure. Case Presentation We present a case of a 44-year-old female with a ruptured non-coronary SOVA diagnosed by echocardiogram during evaluation for exertional dyspnea. A transesophageal echocardiogram (TEE) revealed a 2.1 cm non-coronary SOVA with windsock communication to the right atrium. The patient refused surgery, and two years later, presented with florid right heart failure with preserved left ventricular function. The right ventricle was severely dilated and hypokinetic with right atrial enlargement. After finally agreeing to surgery, a pre-operative catheterization revealed non-obstructive coronaries and a significant left to right shunt with elevated pulmonary pressure. The patient had suboptimal response to diuretic therapy and was sent for successful repair of the aneurysm with the closure of the aorto-atrial fistula via bovine pericardial patch and resolution of the left to right shunt as demonstrated by intraoperative TEE. Her right sided heart failure symptoms subsequently resolved. Discussion SOVA is a rare finding but should still be considered in the differential in young and middle-aged patients with symptoms of acute heart failure, hemodynamic compromise, and a new continuous heart murmur. Early surgical repair is highly recommended to prevent acute and long-term complications.

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

Cited by 2 publications

References 8 publications

Giant left sinus of Valsalva aneurysm as a rare cause of acute myocardial infarction: a case report

Giant left sinus of Valsalva aneurysm as a rare cause of acute myocardial infarction: a case report

A rare variant of a ruptured sinus of valsalva aneurysm forming an aorto-atrial fistula: a case report and review of literature

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