Giant Unruptured Sinus of Valsalva Aneurysm: An Unusual Cause of Right Heart Failure

Abstract

Aneurysm of sinus of Valsalva is a rare cardiac abnormality. Unruptured aneurysm of sinus of Valsalva is usually asymptomatic and often discovered incidentally. However, a large aneurysm can, in rare cases, cause compression of the ventricular outflow tract. We report a case of 17-year-old male with congestive right heart failure with a large, partially thrombosed unruptured aneurysm of the right sinus of Valsalva. The aneurysmal sac was compressing the right ventricular outflow tract causing marked dilatation of the right ventricle and atrium that was confirmed on contrast-enhanced computed tomography imaging. Unruptured sinus of Valsalva aneurysm causing right heart failure in adolescence has been rarely reported in literature.

Rupture of sinus of valsalva aneurysm: earliest presentation in association with ventricular septal defect and aortic regurgitation

“…The clinical presentation may vary from an asymptomatic continuous murmur to heart failure, cardiogenic shock and death depending upon the onset and size of perforation [9]. The principal VSD associated with a ruptured sinus of Valsalva aneurysm is the subaortic type same as seen in our case.…”

Ruptured Sinus of Valsalva Aneurysm Causing Aorto–Atrial Fistula and Acute Heart Failure: A Rare Encounter

“…Unruptured SVAs are often clinically silent; however, large unruptured aneurysms may cause conduction abnormalities, such as complete heart block, myocardial ischemia from compression of coronary arteries, and right ventricular outflow tract obstruction causing acute right heart failure [8] . SVAs are most commonly diagnosed cardiac imaging like echocardiography and often found incidentally.…”

“…TEE has a higher sensitivity of close to 90% in recognizing fistulous tract formation [4] . Cardiac magnetic resonance imaging and CT are alternate modalities to confirm or better categorize echocardiographic findings [8] . In our patient, the fistula origin was unclear and the utilization of CT allowed for accurate diagnosis and surgical planning.…”

Giant aneurysmal of the left sinus of Valsalva in adults

“…Often exhibiting no visible symptoms, sinus of Valsalva aneurysms is usually challenging to be found. Besides, giant unruptured aneurysms may cause conduction abnormalities, such as complete heart block, myocardial ischemia from compression of coronary arteries, infective endocarditis, right ventricular outflow tract obstruction, and dilatation of aortic annulus due to anatomical change 2 . In 90% of Valsalva aneurysm cases, the sinus breaks into the right‐sided chambers, and in the other 10%, it breaks into the left atrium, left ventricle, pulmonary artery, or pericardial cavity 3 .…”