Diagnostic paradox: Ruptured aneurysm of sinus of Valsalva simulating tricuspid valve endocarditis

Hoda, Mehar; Verma, Arushi; Alapati, Sridevi; Alapati, Srilatha; Yarrabolu, Tharakanatha R.

doi:10.1111/echo.13479

Cited by 4 publications

(1 citation statement)

References 9 publications

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“…In this case, postmortem genetic testing was not performed. Other anomalies associated with ruptured SVA, such as atrial and ventricular septal defect, 4,5 bicuspid aortic valve, 4,5 pulmonary stenosis, 4 coarctation of the aorta, 5 and severe aortic insufficiency, 6 were not detected. The patient had no documented infective endocarditis before presentation.…”

Section: Discussionmentioning

confidence: 95%

A Fatal Case of an Undiagnosed Ruptured Aneurysm of the Noncoronary Sinus of Valsalva

Ginelliová¹,

Farkas²,

Iannaccone

2022

Am J Forensic Med Pathol

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Section: Discussionmentioning

confidence: 95%

A Fatal Case of an Undiagnosed Ruptured Aneurysm of the Noncoronary Sinus of Valsalva

Ginelliová¹,

Farkas²,

Iannaccone

2022

Am J Forensic Med Pathol

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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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A multimodality approach to a rare case of ruptured sinus of Valsalva aneurysm with tricuspid valve involvement: a case report

Wilson,

Jacob,

van der Walt

et al. 2023

European Heart Journal - Case Reports

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Background Ruptured sinus of Valsalva aneurysm is a rare disease entity that is potentially life-threatening if left untreated. While imaging is the mainstay of diagnosis, resultant tricuspid valve involvement may mask typical findings providing a diagnostic challenge. Disruption of the tricuspid valve during ruptured sinus of Valsalva aneurysm with consequent tricuspid regurgitation is rare and infrequently described in the literature. Description of the utility and limitations of multimodality imaging in this scenario is equally scarce. Case summary We review the case of a young patient presenting with acute ruptured sinus of Valsalva aneurysm and involvement of the tricuspid valve on a background of severe aortic regurgitation requiring multimodality imaging for diagnostic and pre-surgical assessment. Discussion In young patients presenting with acute decompensation and pre-existing bicuspid aortic valve regurgitation, an increased clinical suspicion of a sinus of Valsalva aneurysm rupture is imperative. Doppler and 3D transoesophageal echocardiographic assessment should be pursued to characterize abnormal flows and clarify aetiology in the context of tricuspid involvement and resultant tricuspid regurgitation. A large-volume left–right shunt in proximity to the tricuspid annulus may result in disproportionately severe tricuspid regurgitation in the absence of annular disruption due to forced systolic opening of the leaflets by shunt flow and ‘windsock’ prolapse. Multimodality imaging can be essential in these cases to adequately assess the extent of the ruptured sinus of Valsalva aneurysm and overcome limitations of single modality imaging.

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Diagnostic paradox: Ruptured aneurysm of sinus of Valsalva simulating tricuspid valve endocarditis

Cited by 4 publications

References 9 publications

A Fatal Case of an Undiagnosed Ruptured Aneurysm of the Noncoronary Sinus of Valsalva

A Fatal Case of an Undiagnosed Ruptured Aneurysm of the Noncoronary Sinus of Valsalva

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

A multimodality approach to a rare case of ruptured sinus of Valsalva aneurysm with tricuspid valve involvement: a case report

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