Association of ruptured sinus of Valsalva aneurysm and congenital ventricular septal defect: a case series

Abstract

Background Ruptured sinus of Valsalva aneurysm (RSOVA) is rare, and it is more common in Asians. Typically, the patient presents with acute/subacute shortness of breath (SOB) and chest pain. Echocardiography is the gold standard for diagnosis in most of these cases. Surgery has remained the first line of management. Case summary We present two cases of RSOVA in which the patients presented to the emergency department with SOB. Their preoperative echocardiography results showed RSOVA into the right ventricle. During surgical repair, ventricular septal defect (VSD) was also found. Discussion RSOVA is frequently associated with other congenital anomalies, and most often with VSD. In our cases, we believe that VSDs were missed preoperatively because either the large aneurysmal sacs covered the VSD or there was overlap between the two shunts. Additionally, in the first case, right ventricular pressure was high approaching systemic pressure, which probably reduced the shunt across the VSD. Early intervention is recommended to prevent endocarditis or enlargement of the ruptured aneurysm; long-term results were excellent after surgical repair. Most patients undergo surgery between 20 and 40 years of age, and the reported survival rate is 95% at 20 years. If left untreated, patients typically die of heart failure or endocarditis within 1 year after onset of symptoms.

Case Report: Right Heart Failure Mistaken for Obesity—A Fault of Telemedicine

“…SVA is an infrequent congenital heart anomaly which results from a regional defect of continuity between the tissue in the aortic wall and aortic annulus. It affects predominantly male patients (4:1) and is typically associated with ventricular septal defect ( 5 , 6 ), bicuspid aortic valve ( 7 ) and aortic regurgitation ( 8 ). SVA are more prevalent in Asian populations and affect predominantly the right coronary sinus.…”

“…Considering that an SVA may be connected with the right ventricle, right atrium, pulmonary artery, pericardial sac or even the mediastinum, the clinical presentation of ruptured SVA varies depending on rapidity of the process and the affected chamber. Acute SVA rupture can lead to sudden onset right heart failure, severe aortic insufficiency or cardiac tamponade ( 10 ), however a small perforation in a dilated sinus may cause more subtle manifestations such as syncope, slow-onset shortness of breath or a gradual decline in exercise tolerance ( 5 ). In the case presented above, the timing of SVA rupture can only be presumed based on when symptoms first appeared, since the patient's home measurements of weight were not recorded.…”

Emergency Cesarean Section in a Parturient with Ruptured Sinus of Valsalva under Spinal Anesthesia: A Case Report

“…She was received at the admitting section with stable vital signs and no signs of cardiorespiratory distress. She weighed 71 kg, and stood at 153 cm, with a BMI of 27.8 kg/m 2 . The heart rate had regular rhythm, with audible grade 4/6 holosystolic murmur heard best at the 2 nd intercostal line, with thrills and heaves.…”

“… 1 The aneurysm is typically silent until it is complicated by rupture. 2 There is no published literature on the incidence of rupture, but it typically occurs at the second to fourth decade of life. 1 The anatomy and speed of which will determine its course, hemodynamic consequences, and prognosis.…”