Right Valsalva Sinus Aneurysm Protruding Into the Right Ventricle: A Case Report

Abstract

A separation between the aortic media and annulus fibrosus causes a rare cardiac abnormality called sinus of Valsalva aneurysm (SVA) that may be congenital or acquired. It is more prevalent in the right coronary sinus (65%-85%) but it has been seen rarely in non-coronary (10%-30%) or Left coronary sinus (<5%). The most common complication is rupture of the Aneurysm. We present an 80-year-old male with expanding right Valsalva sinus aneurysm and protruding into right ventricle. The conventional treatment is surgical repair under cardio-pulmonary bypass or percutaneous catheter closure. The aneurysm was successfully excised surgically under direct guidance of trans-esophageal echocardiography (TEE).

Rupture of right sinus of Valsalva aneurysm protruding into the pulmonary artery with aortic and pulmonary valve endocarditis

“…Rupture of the right aortic SVA draining to the pulmonary artery is a very rare case (6) and to our knowledge, this is the first such case with associated aortic and pulmonary valve endocarditis resulting in valve replacement. Here, we report an unusual case of SVA rupture draining to the pulmonary artery with aortic and pulmonary valve endocarditis.…”

“…Although all three aortic sinuses can rupture, the right aortic sinus does so most commonly, and the receiving chamber is right-sided, resulting in a left-to-right shunt. The most common receiving chamber is the right ventricle; a ruptured right aortic sinus aneurysm draining into the pulmonary artery is extremely rare (6). We present a case of SVA rupture into the pulmonary artery with aortic and pulmonary valve endocarditis.…”

Sinus of valsalva aneurysm repair in an octogenarian using CorMatrix ECM®

“…[16,17] Small asymptomatic stable aneurysms are treated with anticoagulation and close follow-up including MRI or echocardiography monitoring. [9,10,18,19] Successful surgical repair was first reported in 1957 and is recommended when the sinus grows to > 50% larger than the average size of the other two sinuses, compresses surrounding chambers or origin of the main coronary arteries, increases in consecutive echocardiograms (> 0.5 cm/year) or presents incidentally during cardiac surgery. [20][21][22][23][24][25] In order to avoid complications associated with aneurysm enlargement or endocarditis, early surgical repair has been recommended especially since this surgery is associated with low morbidity and mortality, however this has not been established in elderly patients.…”

Echocardiographic evaluation of aorta to right atrial fistula secondary to ruptured sinus of valsalva aneurysm

“…Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly that may be congenital or acquired. [ 1 ] SVA occurs when the aortic media separates from the annulus fibrosis, with aneurysmal rupture representing the most common complication of this cardiac anomaly. The aneurysm predominantly originates from the right coronary sinus and may rupture up to 35% of the time,[ 2 ] most commonly to the right cardiac chambers.…”

“…The aneurysm predominantly originates from the right coronary sinus and may rupture up to 35% of the time,[ 2 ] most commonly to the right cardiac chambers. [ 1 ] Diagnosis of a ruptured sinus of Valsalva can be made by the classic “windsock” appearance on echocardiography. [ 3 ] Emergent surgical intervention should be the treatment of choice for ruptured SVA due to the possibility of rapid cardiac deterioration.…”