Surgery for Ruptured Sinus of Valsalva Aneurysm into Right Ventricular Outflow Tract: Role of Intraoperative 2D and Real Time 3D Transesophageal Echocardiography

Abstract

A major limitation of the 2D echocardiography during surgery for a complex cardiac lesion is its inability to provide an accurate spatial orientation of the structure. The real time 3D transesophageal echocardiography (RT-3D-TEE) technology available in Philips IE 33 ultrasound machine is relatively new to an operation suite. We evaluated its intraoperative utility in a patient, who was operated for repair of a ruptured sinus of Valsalva aneurysm (RSOVA) and closure of a supracristal ventricular septal defect. The VSD and RSOVA were visualized through different virtual windows in a more promising way on intraoperative RT-3D-TEE than on the 2D echocardiography. The acquired images could be virtually cropped and displayed in anatomical views to the operating surgeon for a clear orientation to the anatomy of the lesion. RT-3D-TEE is a potential intraoperative monitoring tool in surgeries for complex cardiac lesions.

Bad Company: Supracristal VSD Presenting with Ruptured Sinus of Valsalva Aneurysm. A Case Presentation with Echocardiographic Depiction and an Analysis of Contemporary Literature

“…3DTEE may be extremely useful in such cases, as en face cropping can be done separately for each defect in different anatomic planes (see movie clip S5) and 3D color Doppler can further delineate differential flow in the VSD and the ruptured SoVA. 10,21 The presence of biventricular enlargement in the setting of ruptured SoVA into a right-sided chamber with minimal valvular aortic regurgitation, as initially seen in our patient by TTE, is highly suggestive of coexistent ventricular septal defect. Left ventricular enlargement due to systolic VSD flow is a chronic progressive entity beginning in childhood and may be the sole hemodynamic footprint of a previously nonrestrictive SCVSD that might be unapparent at the time of SoVA diagnosis.…”

“…In general, the continuity of the SoVA wall should be scanned with close attention, in multiple planes, with particular care to identify isolated jets on Doppler with the distinct characteristics of VSD and/or ruptured sinus of Valsalva flow. 3DTEE may be extremely useful in such cases, as en face cropping can be done separately for each defect in different anatomic planes (see movie clip S5) and 3D color Doppler can further delineate differential flow in the VSD and the ruptured SoVA …”