Concurrent congenital pseudoaneurysm of mitral-aortic intervalvular fibrosa and left sinus of Valsalva aneurysm

Abstract

Either the pseudoaneurysm of mitral-aortic intervalvular fibrosa or the aneurysms of Valsalva are rare cardiac conditions. Concomitant diagnosis in the same patient is extremely rare with only one case report. Herein, we described an extremely rare case of concomitant pseudoaneurysm of mitral-aortic intervalvular fibrosa and aneurysm of left sinus of Valsalva in 21-year-old black man admitted with new-onset of heart failure (NYHA class III) diagnosed by transesophageal echocardiography. Despite medical therapy optimization for heart failure, the patient died waiting for cardiac surgery. Regarding the case, we discussed possible etiology, clinical presentation and the role of echocardiography in the diagnosis and surgical approach of this very rare association.with enalapril and furosemide, and antibiotic, and was referred to Angola. At admission, the patient reported a slight improvement of cough and peripheral edema, maintaining, however, the remaining symptoms He reported no fever, thoracic trauma, previous cardiac surgery or syncope.Physical examination revealed a eupneic patient with a supine blood pressure of 100/60 mmHg, a pulse rate 106 beats/min, regular rhythm. Cardiac auscultation revealed grade 3/6 pansystolic murmur, which was audible in the apex, radiating to the axila. Pulmonary auscultation revealed bilateral basal rales. The remaining physical examination was unremarkable. Complementary diagnostic exams included routine laboratory tests,which revealed no significant abnormalities; plan chest X ray showed cardiomegaly and pulmonary interstitial edema; and 12-lead electrocardiography revealed a sinus rhythm with a heart rate of 90 beats/ min, and signs of left atrial and ventricular hypertrophy, with no other alterations.Two-dimensional transthoracic echocardiography (TTE) revealed an echolucent area adjacent to the aortic valve that was freely com-Correspondence to: Valdano Manuel -Clínica Girassol, Revolução de Outubro Avenue, second floor. 9. Joshi SS, Jagadeesh AM, Furtado A, Bhat S (2013) Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery. Ann Card Anaesth 16: 40-43. [Crossref] 10. Waldhausen JA, Petry EL, Kurlander GJ (1966) Successful repair of subvalvular annular aneurysm of the left ventricle. N Engl J Med 275: 984-987. [Crossref]

Sinus of Valsalva aneurysm in Africa: a literature review

“…In the present review, no cases of BAV were found, and VSD was found in only 4.3% of cases (one patient). In turn, SOVAs are associated with other congenital aneurysms, such as submitral aneurysms [16], fibrous mitral-aortic aneurysm [18], coronary artery aneurysm [14] and membranous septum [6]. This was a frequent finding in our review.…”

“…A total of 48 papers were identified, of which 28 records not related to the theme were excluded. A total of 20 full-text papers representing 23 patients, children and adults included, were included in this review [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

“…A case series with 4 patients and 19 clinical cases of SOVA were identified from reports published between 1962 and 2021 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Overall, 23 patients with SOVA were identified, and there were 14 males (60.8%) and 9 females (39.1%) (male/female ratio: 1.6/1).…”

“…The association of SOVA and other congenital aneurysms was found in 4 patients [6,14,16,18]. SOVA was associated with left ventricular noncompaction (LVNC) in 2 patients [4,10].…”

“…Surgical treatment is recommended for the 23 (100%) patients. Of this, 1 patient died of congestive heart failure refractory to treatment waiting for cardiac surgery [18], 1 patient with a high surgical risk was refused by the surgical team [13], and 3 patients refused surgery [15,18,20]. Fifteen patients underwent surgical treatment with no surgical mortality.…”