Giant unruptured sinus of Valsalva aneurysm successfully managed with valve-sparing procedure – a case report

Abstract

Background: Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, with an incidence of less than 1% of open heart surgery cases. Its evolution is most frequently silent, being found incidentally or discovered in the event of its acute rupture. Non-ruptured giant SVAs may cause unusual clinical manifestations, as a consequence of their protrusion into the heart chambers or compression of the coronary vessels and are frequently associated with aortic insufficiency of various degrees of severity. The gold standard treatment for SVAs consists of complete replacement of the aortic root and valve. However, in certain cases, valve-sparing procedures may prove to be a more suitable alternative. Case presentation: A 68-year-old male patient presented with dyspnea as symptom caused by a large (> 5 cm) right sinus of Valsalva aneurysm. The aneurysm was occupying most of the right ventricle and was associated with severe aortic regurgitation. The surgical treatment of the condition involved valve-sparing root reconstruction procedure (remodeling technique), completed with external stabilization of the aortic valve annulus via running suture annuloplasty. Following the uneventful intervention, the patient did well and his status improved. The follow-up transthoracic echocardiography obtained 1 month after surgery showed a fully competent aortic valve with no regurgitation. Conclusions: Despite complete aortic root and valve replacement being considered the safest approach to large SVAs complicated with aortic insufficiency, valve-sparing procedures should not be overlooked in case of a dilated aortic root with uncalcified aortic valve. Performing valve-sparing by applying a remodeling technique operation completed with annuloplasty reduces aortic valve insufficiency, avoiding side-effects related to implanted valves.

Large sinus of Valsalva aneurysm presenting as acute coronary syndrome

“…2 Nonruptured aneurysms are mostly asymptomatic but can cause dyspnea, angina, or arrhythmias. 3 Patients can present with symptoms similar to acute coronary syndromes when the coronary arteries are obstructed, as in this case. The most fatal complication is acute rupture.…”

A surgical case of unruptured giant sinus of Valsalva aneurysm with right ventricular outflow tract stenosis using double closure technique

“…As reported by Wang et al [4][5][6] , residual AI has a poor prognosis often requiring aortic replacement or valvuloplasty, or aortic root replacement. Polos et al 7 performed a valve-sparing root reconstruction procedure(remodeling technique)for an SVA and Carlotta et al 8 conducted an aortic valve repair using a hemi-remodeling technique. However, Wingo et al 9 and Abraiov et al 10 reported in a retrospective study that good results can be obtained by patch closure or aneurysm plication.…”

Rupture of Aortic Sinus Aneurysm Caused by Trauma

“…Authors' information 1 Department of Ultrasonography,Yanbian University Hospital,Yanji 133000, Jilin,China. 2 Nursing Department,Yanbian University Hospital,Yanji 133000, Jilin,China.…”

“…Aneurysms of the sinuses of Valsalva are de ned as dilatation of the aortic root region between the aortic annulus and the sinotubular junction.They may be congenital, especially secondary to connective tissue disorders or in conjunction with congenital cardiac defects, or acquired such as secondary to infections or trauma [1].Sinus of Valsalva aneurysm is just an uncommon cardiac anomaly,a congenital or acquired cardiac defect that is present in roughly 0.09% of the general population.With an incidence of less than 1% of opening heart surgery cases.The gold standard treatment for Sinus of Valsalva aneurysm consists of complete replacement of the aortic root and valve [2,3].Aortic sinus aneurysm is a rare and usually asymptomatic lesion.Rupture leads to chest tightness and dyspnea, suggesting left or right heart failure. Rupture of Valsalva sinus remains a very rare and deadly complication of Valsalva sinus aneurysm with a high mortality rate.Surgery is the primary treatment [4,5].…”