Asian Cardiovasc Thorac Ann 2004;12:90
© 2004 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Ruptured Sinus of Valsalva Aneurysm
Ganesh Shanmugam, MCh,
Robert Jeffrey, FRCS
Department of Cardiothoracic Surgery Aberdeen Royal Infirmary Scotland, UK
For reprint information contact: Robert Jeffrey, FRCS Tel: 44 1224 553 773 Fax: 44 1224 553 506 Email: rrjeffrey{at}abdn.ac.uk Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Foresterhill Aberdeen AB25 2ZN, Scotland, U.K.
A 48-year-old lady was admitted with chest pain and palpitations. She was in cardiogenic shock and renal failure. Cardiac examination revealed tachycardia and a machinery murmur.Transthoracic Echo showed aneurysmal dilatation of the right sinus of Valsalva (Figure 1
) and a unidirectional continuous mosaic jet from the aorta to the right ventricle. A diagnosis of rupture of the sinus of Valsalva was made. Angiography confirmed the diagnosis (Figure 2). The coronaries were normal.
View larger version (49K):
[in this window]
[in a new window]
|
Figure 1. Transthoracic echo showed the typical "windsock appearance" (arrow) of the aneurysm of the sinus of Valsalva.
|
|
At surgery a windsock aneurysm of the right coronary sinus of Valsalva was seen. The tip of the aneurysm had multiple fenestrations. The windsock was excised and a Dacron patch sewn into the right coronary sinus to obliterate the aortic side of the aneurysm.
Sinus of Valsalva aneurysms are thin walled tubular outpouchings. The underlying lesion is a thinning of the aortic sinus wall, due to congenital absence of normal elastic and muscular tissues, just above the aortic annulus at the point of the leaflet hinge. The aortic media separates from the annulus and retracts upward. The part of the sinus between the annulus and the upward retracted media, becomes aneurysmal. These defects usually arise from the right sinus or the adjacent half of the noncoronary sinus and may rupture chiefly into the right heart chambers, resulting in an aortocardiac fistula. The hemodynamic consequences are determined by the size of the shunt, the chamber of rupture and the rapidity.
