Unusual Presentation of Heart Failure Secondary to Ruptured Aneurysmal Sinus of Valsalva: A Case Report

Sinus of Valsalva Aneurysm (SOVA) arises from an abnormal dilation of the aortic root, leading to enlargement between the aortic annulus and the sinotubular junction. Although often presenting without symptoms, these aneurysms bear the potential for life-threatening complications, primarily from the looming risk of rupture. We present the case of a 42-year-old Malay gentleman with a history of bilateral pedal edema and dyspnea on exertion who was diagnosed with a ruptured sinus of Valsalva aneurysm. The patient underwent successful surgical repair of the aneurysm, leading to symptomatic improvement and favorable outcomes. This case highlights the importance of early diagnosis and prompt surgical intervention in managing this uncommon condition.

Surgery for sinus of Valsalva aneurysm： 33-year of a single center experience

Background Sinus of Valsalva aneurysm （SVA） is a rare anomaly and few large or long-term series are well established.This study was designed to review 33-year surgical experience of SVA in one center.Methods From August 1980 to December 2013,patients with SVA underwent surgical repair were retrospectively studied.Results A total of 160 patients were identified with mean age of （30±12） years and 112 （70％） of them were males.The right coronary sinus origin of SVA was found in 108 patients （67.5％）,the non-coronary sinus in 51 patients （31.9％）,and the left coronary sinus in one patient （0.6％）.The rupture of 3VA into the right ventricle was identified in 89 （55.6％） cases,the right atrium in 61 （38.1％）,the left ventricle in 2 （1.3％） and no rupture in 8 （5.0％）.Ventricular septal defect （VSD） and aortic regurgitation （AR） were found in 59 （37％） and 45 （28％） patients respectively.An approach via the involved chamber was used in 86 patients （54％）,aortotomy in 8 （5％）,and a combined approach in 66 （41％）.Either direct suture （56,35％） or patch （104,65％） closure were used to repair the SVA.The VSD was closed with a patch （44/59,75％） or direct suture （15/59,25％）.aortic valve replacement （AVR） was performed in 23/45 （51％） and aortic valvuloplasty （AVP） in 9/45 （20％） patients combined with AR.There were 3 hospital deaths （1.9％） and 2 late deaths and 84％ of the patients were followed up for （17.6±4.2） years.New York Heart Association functional class improved significantly after surgery （P＜0.01）.Actuarial survival was 94％ at 10 years,and 88％ at 20 years.Conclusions Surgical treatment of SVA is safe and effective,ruptured SVA or unruptured SVA with VSD and/or AR should be repaired surgically as early as possible.However,late progressive AR is still a risk during long-term follow-up,and early aggressive measures are recommended.These include more use of a combined approach to achieve optimal evaluation of lesions,more patch repairs to reduce the chance of recurrence,and more AVR in patients with moderate to severe AR.

Outcome of surgery for sinus of Valsalva aneurysm with discrete membranous subaortic stenosis

Background Sinus of Valsalva aneurysm （SVA） is a rare cardiac anomaly, and SVA with discrete membranous subaortic stenosis is even rarer. The aim of the study was to make sure the incidence of SVA with discrete membraneous subaortic stenosis in SVA and their surgical results. We retrospectively analyzed 234 patients receiving surgical repair of SVA and reported the incidence of ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis. We also reported seven cases of SVA combined with discrete membranous subaortic stenosis and their surgical results.Methods Between January 1999 and December 2009, seven patients of SVA with discrete membranous subaortic stenosis underwent surgical repair of SVA and resection of subaortic discrete membrane. There were six male and one female patients. The mean age was （33.71±13.25） years （range 16–52 years）. Associated cardiovascular lesions were aortic regurgitation （n=7）, ventricular septal defect （n=5）, coarctation of aorta （n=1）, bicuspid aortic valve （n=1）, patent ductus arteriosus （n=1）, and aortic valve stenosis （n=1）. The aortic valve was replaced in four patients and valvuloplasty was done in three. The other co-existing anomalies were corrected at the same time. All the seven patients were followed up from 18 to 125 months （mean （63.14±39.54） months）. Among 234 SVA patients who underwent surgical repair, the number of cases with coexisting ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis was 129, 108, and 7, respectively.Results There was neither early death after operation nor late death during the follow-up period. All the seven patients were in the New York Heart Association （NYHA） functional classes I and II. There was no recurrence of discrete subaortic membrane during the follow-up period. The incidence of ventricular septal defect, aortic valve incompetence, and discrete membranous subaortic stenosis among 234 SVA patients was 55.13%, 46.15%, and 2.99%, respectively.Conclusions Surgical repair of SVA with discrete membranous subaortic stenosis showed good mid-term results. Resection of discrete subaortic membrane should be done actively while repairing SVAs. Long-term results need to be followed up.

Complication of interventional treatment:noncoronary sinus of Valsalva aneurysm ruptured into the right atrium

Sinus of Valsalva aneurysm is a rare cardiac anomaly thought to be caused by a deficiency of fusion of the aorta＇s media with the aortic valve＇s annulus fibrosis, or by actual detachment. It is usually congenital but less commonly associated with endocarditis, atherosclerosis, trauma, syphilis, or aortic dissection. Since the first report in the mid-eighteenth century, sinus of Valsalva aneurysm has been described increasingly. The estimated prevalence of the disease is about 1% in patients undergoing open-heart surgery, and the morbidity is higher in the oriental than in Western population.

UNRUPTURED ANEURYSM OF THE LEFT CORONARY SINUS OF VALSALVA ASSOCIATED WITH ANEURYSM OF THE INTERVENTRICULAR SEPTUM

Aneurysms of the coronary sinus of Valsalva are commonly seen in the oriental people.Their clinical courses and prognosis depend on the location,size and propensity to rupture.They often occur in the right coronary sinus and tend to rupture to the

Aneurysmal dilatation of the aortic sinuses of Valsalva -- beyond Marfan syndrome： a single centre experience and review of the literature

Aneurysmal dilatation of the aortic sinuses of Valsalva has been most extensively documented in the setting of aortopathies, particularly Marfan syndrome. On the other hand, there is limited data in the literature about congenital sinus of Valsalva aneurysms outside this context. For the purpose of this review, we carried out a literature search on aneurysmal dilatation of the sinuses of Valsalva in Marfan syndrome, and compared this with congenital sinus of Valsaiva aneurysms, also including data from a case series from our institution. In conclusion, there are differences in management of aortic dilatation in Marfan syndrome and congenital sinus of Valsalva aneurysms. Though less weil-recognised, congenital aneurysms are often associated with significant morbidity and mortality and timely intervention is necessary.

Secondary coronary artery ostial lesions:Three case reports

BACKGROUND Atherosclerosis is one of the main causes of coronary artery ostial lesions seen clinically.Secondary coronary artery ostial lesions are rare,and cases reported previously were associated with syphilitic vasculitis and aortic dissection.Here,we report three rare cases of secondary coronary ostial lesions.Due to their rareness,these lesions can easily be neglected,which may lead to misdiagnosis and missed diagnosis.CASE SUMMARY We present three patients with acute myocardial infarction and unstable angina caused by secondary coronary artery ostial lesions.In Case 1,coronary angiography(CAG)revealed 90%stenosis of the left main coronary ostium.Chest contrast computed tomography(CT)suggested thymic carcinoma invading the left main coronary ostium.Coronary artery bypass grafting and tumor resection were performed.In Case 2,echocardiography revealed a sinus of Valsalva aneurysm(SVA)-like dilatation.CAG showed a right coronary sinus giant aneurysm and complete obstruction of the right coronary artery(RCA)ostium.Aortic contrast CT confirmed these findings.The Bentall procedure was performed.In Case 3,CT CAG identified an anomalous origin of the right coronary artery(AORCA)from the left sinus of Valsalva coursing between the aorta and pulmonary trunk,causing severe RCA ostium stenosis by compression.Surgical correction of the AORCA was performed.CONCLUSION The cases reported here suggest that we should consider other causes of coronary ostial lesions other than atherosclerosis.