Transcatheter closure of ruptured sinus of Valsalva aneurysm in a pregnant woman

Abstract

Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that is usually congenital, but may be acquired. They are usually asymptomatic unless they compress adjacent structures, develop thrombosis, or rupture. A ruptured SVA (RSVA) can lead to rapid hemodynamic deterioration and often needs to be addressed emergently. Surgical correction has traditionally been the treatment of choice for RSVA; however, lately they have been successfully closed percutaneously using various transcatheter devices. Few cases of RSVA during pregnancy have been reported which were conservatively or surgically managed. There is no documented case of transcatheter closure of RSVA during pregnancy. We report the first case of successful percutaneous device closure of RSVA using an Amplatzer duct occluder in a pregnant woman presenting with heart failure due to RSVA at 26 weeks of gestation. <Learning objective: Ruptured sinus of Valsalva aneurysm (RSVA) is traditionally repaired by surgery but more recently amenable to percutaneous intervention. Management of RSVA during pregnancy is complex and has been managed by surgery in the past incurring significant risk to fetus due to effects of cardiopulmonary bypass. We report a case of RSVA in pregnancy that was closed by transcatheter closure for the first time, thereby significantly reducing maternal and fetal risks. While risks are present during pregnancy, emergently indicated life-saving invasive cardiac procedures should not be denied solely on the pregnant state.>.

Keywords: Percutaneous; Pregnancy; Ruptured aneurysm; Sinus of Valsalva aneurysm; Transcatheter intervention.

Fig. 1

Transthoracic echocardiographic images in parasternal short-axis view demonstrating small perimembranous ventricular septal defect and ruptured aneurysm of right coronary sinus of Valsalva with left to right shunt into the right ventricular outflow tract.

Fig. 2

Angiographic image in 30° right anterior oblique projection demonstrating right coronary sinus of Valsalva aneurysm (SVA) and contrast spilling into right ventricular outflow tract through the ruptured sinus (thick arrow), mouth of aneurysm measuring 8 mm (thin arrow).

Fig. 3

Post-procedure angiographic image in 30° right anterior oblique projection demonstrating a well seated Amplatzer Duct Occluder (ADO) I device across the ruptured aneurysm of right coronary sinus of Valsalva (RSVA) without any residual shunt.

Fig. 4

Post-procedure transthoracic echocardiogram in parasternal long-axis view showing device in good position across the mouth of sinus of Valsalva aneurysm.