Transcatheter Closure of Ruptured Sinus of Valsalva Aneurysm: Report of two cases

Abstract

A ruptured sinus of Valsalva aneurysm (RSVA) is a rare cardiac anomaly. Traditionally, RSVAs were repaired surgically; however, percutaneous transcatheter closure is the current treatment of choice. We report two cases of RSVA which were closed using this approach. The first case was a 45-year-old female who presented to the Royal Hospital, Muscat, Oman, in 2014 with a RSVA in the right ventricle. The second case was a 39-year-old male who was admitted to the Sultan Qaboos University Hospital, Muscat, in 2015 with a large multifenestrated RSVA extending into the right ventricle outflow tract. Each patient underwent transcutaneous cardiac catheterisation using three-dimensional echocardiography. Both interventions were technically successful; however, the second patient required a subsequent surgery due to the continuing presence of a significant shunt. Transcatheter closure of RSVAs is an effective alternative to surgical repair, although large multifenestrated RSVAs should be repaired surgically to ensure complete closure.

Keywords: Cardiac Catheterization; Case Report; Oman; Ruptured Aneurysm; Sinus of Valsalva; Three-Dimensional Echocardiography.

Figure 1

A: Two-dimensional transoesophageal echocardiography (TOE) in the short axis view showing a right sinus of Valsalva aneurysm (RSVA) extending into the right ventricle (arrow) of a 45-year-old female patient. B: Post-closure three-dimensional TOE in the short axis view showing the position of a cardiac catheter device (arrow) across the aneurysm. C: Post-closure lateral fluoroscopy showing the satisfactory position of the device (arrow), with no residual shunts or aortic valve regurgitation. RV = right ventricle.

Figure 2

A: Two-dimensional transoesophageal echocardiography (TOE) in the short axis view showing a multifenestrated right sinus of Valsalva aneurysm (RSVA) into the right ventricular outflow tract (arrow) of a 39-year-old male patient. B: Post-closure three-dimensional TOE in the short axis view showing the position of two cardiac catheter devices (short arrow) across the aneurysm, with the right ventricular outflow tract wide open. C: Post-closure lateral fluoroscopy showing the position of the devices. RVOT = right ventricular outflow tract.