Unusual double-chambered right ventricle induced by ruptured sinus of Valsalva aneurysm: A case report

Abstract

A sinus of Valsalva aneurysm (SVA) is a rare cardiac condition. Among SVAs, the incidence of rupture is reported about 34-47% [1,2]. More than 97% of all ruptured aneurysms originated in either the right coronary sinus or the non-coronary sinus. Most SVA tended to rupture into the right ventricle (RV) or the right atrium. We describe a case of a double-chambered RV (DCRV) induced by a ruptured SVA with multi-factors. Case reportThe subject was a 54-year-old male who experienced easy fatigability on exertion. Soon after birth, a cardiac murmur was auscultated and ventricular septal defect (VSD) was diagnosed. Because of a small defect and a small amount of left-to-right shunt, closure of VSD had not been required. The patient had not been hospitalized before and had an unremarkable medical history without VSD. He had been experiencing easy fatigability since 53 years of age, therefore he consulted our department of adult congenital heart disease. A bounding pulse was palpable, and a Levine grade V/VI continuous murmur was auscultated at the left sternal boarder. An electrocardiogram showed sinus rhythm with a left atrial load. Chest radiography showed

Double chambered right ventricle with ruptured sinus of Valsalva: rare entity

“…To accord with Nakashima et al study, our patients also had similar DCRV hemodynamics but in disagreement to their findings, our case had demonstrated the presence of abnormal muscular band or moderator band identified by TTE and cardiac MRI modalities. 3 Moreover, our study had elucidated the diagnosis of SVAs and DCRV morphology with non-invasive methods as in identical to Hu et al 5 The publication of case report literatures concerned with DCRV in SVAs association either in the presence or absence of VSD are summarized in the Table 1.…”

“…But this is the first paper that has documented the presence of DCRV due to ruptured SVAs pathology and combined factors in the absence of VSD in the Indian national. Previously, Nakashima et al study had suggested the three possible mechanism for the development DCRV because of SVAs pathology as follows: protruding of right SVA into RV; presence of jet lesion and thickened RV in identical to our opinion in this case 3. We believe that our patients should have developed DCRV morphology even before the device closure itself because elevated RV stroke volume owing to left to right shunt might have resulted in stenosis and increased pressure gradient across RV mid portion.…”

“…Earlier report had demonstrated the occurrence of above stated three diseases in same patient. [3][4] However, to the best of our knowledge, this is the first case report on DCRV induced by SVAs in synergy with other associated multifactor and without VSD among the Indian population. The current report describes a case of the above stated disease occurring at age of 59 years old gentleman and stresses the importance of high level of suspicion for DCRV is often required with such kind of cardiac anomalies.…”