A Large, Unruptured, Aneurysm of Right Sinus of Valsalva, Extending Behind the Main Pulmonary Artery Associated with Bicuspid Aortic Valve-a Rarest Presentation

Abstract

Background: Aneurysm of Sinus of valsalva is caused due to lack of the continuity between the middle layer of the aortic wall and aortic valves.Case report: A patient presented with dyspnoea and chest pain. Computed tomographic angiocardiography revealed dysplastic aortic valve and aneurysm of right sinus of valsalva. We presenting here a case with bicuspid aortic valve complicated with aneurysm of right sinus of valsalva. The aneurysm of sinus of valsalva was extracardiac and extending behind the main pulmonary artery and to the left. Computed tomographic angiocardiography revealed dysplastic aortic valve, para valvular aneurysmal sac communicating with aortic root as well as to left ventricle (? Pseudo-aneurysm). Opening of the aneurysm of sinus of valsalva was closed with Dacron patch from inside of the aorta. Aortic valve was replaced with sorin mechanical valve, size 21. Postoperative period was uneventful and patient was discharged on 7th postoperative day in good general condition. Patient is doing well in follow up visits.Discussion: This is associated with other heart defects, Ventricular septal defect in 30-60%, bicuspid valve (10%), and aortic stenosis (6.5%). Sinus of valsalva aneurysm recurrence per se is rare [1,2]. There is no doubt of the indication of surgical repair for symptomatic Sinus of valsalva aneurysm because this represents a significant risk of death. Operative mortality is generally low.Conclusion: This is the rare presentation of the aneurysm of right sinus of valsalva and is first time in literature because of following reasons.a. Aneurysm of sinus of valsalva was originating from the right sinus and was extending behind the main pulmonary artery.b. This was compressing the left anterior descending artery and causing angina like symptoms.c. This was associated with bicuspid aortic valve which is also a rare occurrence (10%) with aneurysm of sinus of valsalva. Case ReportWe presenting here a case of the patient with bicuspid aortic valve complicated with aneurysm of right sinus of valsalva. The aneurysm of sinus of valsalva was extracardiac and extending behind the main pulmonary artery and to the left. A 45 years old Muslim male patient, carpenter by occupation was admitted with chief complaints of shortness of the breath and chest pain for 1 month. He was having orthopnoea and paroxysmal nocturnal dyspnoea and swelling of the feet. His vitals were stable with pulse rate 96/min, blood pressure 130/50 mm Hg, and respiratory rate 14/min. On auscultation S1 was normal and S2 was soft with grade III/VI diastolic murmur in aortic area. Patient was properly investigated. ECG showed sinus rhythm and X-ray chest was showing cardiomegaly. Transthoracic echocardiography showed calcified bicuspid aortic valve, severe aortic regurgitation, grade II mitral regurgitation and that was appeared to be as dissecting flap in ascending aorta with 75% ejection fraction ( Figure 1). Computed tomography chest was domne and it showed large pseudo-aneurysm of right sinus of Valsalva (Figures 2 & 3...