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. 2016:2016:4654031.
doi: 10.1155/2016/4654031. Epub 2016 Nov 2.

Surviving All Odds: A Unique Case of Multiple Congenital Unruptured Sinus of Valsalva Aneurysms Involving Both Left and Right Coronary Sinuses with Biventricular Dysfunction and Heart Block

Aniketh Vijay B  1 , Vikrant Vijan  1 , Navin Mathew  1
Affiliations

Surviving All Odds: A Unique Case of Multiple Congenital Unruptured Sinus of Valsalva Aneurysms Involving Both Left and Right Coronary Sinuses with Biventricular Dysfunction and Heart Block

Aniketh Vijay B et al. Case Rep Cardiol. 2016.

Abstract

Aneurysms of the sinus of Valsalva are very uncommon, with an incidence ranging from 0.1 to 3.5% of all congenital heart defects. Very few cases have been reported in the literature that presented with involvement of two or more sinuses. We report a case of 27-year-old male with a history of exertional breathlessness of one-month duration. After complete evaluation using transesophageal echocardiography (TEE) and multiple detector computed tomography (MDCT) scanning, the patient was diagnosed to have large congenital unruptured sinus of Valsalva aneurysms involving both left and right coronary sinuses with extension into the interventricular septum. The patient also displayed second-degree heart block (Mobitz type 2) and biventricular dysfunction. The patient was managed successfully. We present the case with an aim to highlight the management challenges including intraoperative and postoperative complications that are associated with unruptured sinus of Valsalva aneurysms of ≥2 sinuses.

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Conflict of interest statement

The authors declare that there is no conflict of interests regarding the publication of this paper.

Figures

Figure 1
Figure 1
Transesophageal echocardiography∗ revealed left sinus of Valsalva aneurysm with thrombus within it causing RVOT obstruction. ∗Aortic valve long-axis view at midesophageal level.
Figure 2
Figure 2
Transesophageal echocardiography∗ with color Doppler revealed mild-to-moderate aortic regurgitation due to the prolapse of the left coronary cusp into the left aneurysm of sinus of Valsalva. ∗Aortic valve long-axis view at midesophageal level.
Figure 3
Figure 3
Transesophageal echocardiography∗ revealed left aneurysm of sinus of Valsalva (LASV) and right aneurysm of sinus of Valsalva (RASV) with thrombus within it, causing RVOT obstruction. ∗Aortic valve short-axis view at midesophageal level.
Figure 4
Figure 4
MDCT aortogram suggested left aneurysm of sinus of Valsalva (LASV) and right aneurysm of sinus of Valsalva (RASV) with extension into the interventricular septum.
Figure 5
Figure 5
MDCT chest coronal section confirmed left and right sinus of Valsalva aneurysms.
Figure 6
Figure 6
The 3D reconstructed image with MDCT aortogram revealed left aneurysm of sinus of Valsalva (LASV; size: 5.4 × 5.7 cm) and right aneurysm of sinus of Valsalva (RASV; size: 4.6 × 2.7 cm) with extension into the interventricular septum; left coronary artery arising from the roof of the left diverticulum.
Figure 7
Figure 7
A 3D reconstructed MDCT chest coronal section image indicating left aneurysm of sinus of Valsalva (LASV).
See this image and copyright information in PMC

References

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