Sinus of valsalva aneurysm.
Article Type: Case study
Subject: Aneurysms (Diagnosis)
Aneurysms (Care and treatment)
Aneurysms (Case studies)
Echocardiography (Usage)
Echocardiography (Health aspects)
Authors: Mantas, Alexi M.
Carry, Melissa M.
Pub Date: 10/01/2009
Publication: Name: Baylor University Medical Center Proceedings Publisher: The Baylor University Medical Center Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 The Baylor University Medical Center ISSN: 0899-8280
Issue: Date: Oct, 2009 Source Volume: 22 Source Issue: 4
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 209406701
Full Text: A 63-year-old man was in good health with well-controlled hypertension and dyslipidemia when he developed progressive dyspnea one day following an uncomplicated and unrevealing routine screening colonoscopy. Physical examination, electrocardiogram, and chest radiograph revealed hypotension, tachycardia, jugular venous distension, cardiomegaly, grade III/VI holosystolic murmur at the apex, and bilateral basilar pulmonary rales. Laboratory investigation disclosed mild troponemia, azotemia, elevated brain natriuretic peptide, and elevated acute-phase reactants. Echocardiography revealed an unruptured noncoronary sinus of Valsalva aneurysm (SVA) protruding into the left atrium, obstructing mitral outflow while also causing acute severe mitral regurgitation (Figure 1).

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SVAs are exceedingly rare congenital or acquired degenerations of connective tissue from atherosclerosis, infection, or trauma resulting in dilations of one of three aortic sinuses: most commonly right, occasionally noncoronary, and rarely left. Unruptured SVAs are usually clinically silent and found incidentally during routine echocardiography. Occasionally, the physical presence of SVAs can precipitate arrhythmias, obstruct a coronary artery resulting in myocardial ischemia, or disrupt normal hemodynamics. Ruptured SVAs have a varied presentation, ultimately depending on the size, progression, and chamber into which rupture occurs.

Surgical correction is indicated for ruptured SVAs and unruptured SVAs of large size and those with complications, including but not limited to altered hemodynamics or conduction abnormalities (1). Our patient presented with uncompensated New York Heart Association class III-IV heart failure and was medically stabilized. He then underwent aneurysm resection followed by valve-sparing patch repair of the aortic root along with mitral valve repair with an annuloplasty ring. The patient is currently symptom free 12 months postoperatively following uncomplicated surgical correction (Figure 2).

[FIGURE 2 OMITTED]

(1.) Feldman DN, Roman MJ. Aneurysms of the sinuses of Valsalva. Cardiology 2006;106(2):73?1.

Alexi M. Mantas, MD, and Melissa M. Carry, MD

From the Department of Internal Medicine (Mantas) and the Division of Cardiology (Carry), Baylor University Medical Center, Dallas, Texas.

Corresponding author: Alexi M. Mantas, MD, Resident, Department of Internal Medicine, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, Texas 75246 (e-mail: Alexi.Mantas@BaylorHealth.edu).
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.