Unruptured Sinus of Valsalva Aneurysm with Right Ventricular Outflow Obstruction

Abstract

The recommended operative management of unruptured sinus of Valsalva aneurysm consists of closure of the mouth of the aneurysm with or without aortic valve surgery. We report a case of unruptured aneurysm producing right ventricular outflow tract obstruction. Closure of the mouth of the aneurysm failed to relieve the obstruction, which was subsequently achieved by excising the aneurysmal wall overlying the outflow tract.

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

“…Other congenital forms of infundibular stenosis include reactive myocardial hypertrophy that is secondary to pulmonary valvular stenosis or, much less commonly, stenosis of the ostium of the infundibulum itself. Case reports of other causes include a pouch of accessory tricuspid valve tissue or an accessory tricuspid valve leaflet (370), fibrous tags from the valve openings of the inferior vena cava or coronary sinus that obstruct the RVOT (371), and aneurysms of either the aortic sinus of Valsalva (372,373) or the membranous interventricular septum (374).…”

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

“…369 Other congenital forms of infundibular stenosis include reactive myocardial hypertrophy that is secondary to pulmonary valvular stenosis or, much less commonly, stenosis of the ostium of the infundibulum itself. Case reports of other causes include a pouch of accessory tricuspid valve tissue or an accessory tricuspid valve leaflet, 370 fibrous tags from the valve openings of the inferior vena cava or coronary sinus that obstruct the RVOT, 371 and aneurysms of either the aortic sinus of Valsalva 372,373 or the membranous interventricular septum. 374 Subinfundibular stenosis or double-chambered right ventricle is a rare form of outflow obstruction that results in the RV being divided into a high-pressure inlet portion and a low-pressure outlet portion by a thick muscle bundle, the hypertrophied septoparietal trabeculation, an anomalous apical shelf, or an abnormal moderator band.…”

<![CDATA[<B>Left sinus Valsalva aneurysm into anterior wall of right ventricle</B>]]>

“…The first case was reported in 1961 by Heiner et al In this report, there was a fistula from the aorta to the left atrium, which was indistinguishable from the neck of the VSA [5]. Since then, several works have been published [6][7][8]. James et al recently presented their 32-year experience from 1971 to 2003 involving 22 cases treated by surgery, of which 15 had associated lesions; six with interventricular septum defect, six with aortic insufficiency and three aortic coarctation [1].…”

“…Symptoms normally are related to associated heart defects and generally the patient evolves with dyspnea or congestive heart failure as in the current case. Apart from Doppler echocardiography, heart catheterism is definitive [7]. Treatment consists in resection of the aneurysm and closure of the aneurysmatic neck using a bovine pericardium patch with correction of associated lesions.…”