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Case Reports
. 2020 Jan 8;15(1):6.
doi: 10.1186/s13019-020-1061-1.

Giant unruptured sinus of Valsalva aneurysm successfully managed with valve-sparing procedure - a case report

Miklós Pólos  1 , Cristina-Maria Șulea  2 , Kálmán Benke  3 , Bence Ágg  3 , Attila Kovács  3 , István Hartyánszky  3 , Béla Merkely  3 , Hans-Joachim Schäfers  4 , Zoltán Szabolcs  3
Affiliations
Case Reports

Giant unruptured sinus of Valsalva aneurysm successfully managed with valve-sparing procedure - a case report

Miklós Pólos et al. J Cardiothorac Surg. .

Abstract

Background: Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, with an incidence of less than 1% of open heart surgery cases. Its evolution is most frequently silent, being found incidentally or discovered in the event of its acute rupture. Non-ruptured giant SVAs may cause unusual clinical manifestations, as a consequence of their protrusion into the heart chambers or compression of the coronary vessels and are frequently associated with aortic insufficiency of various degrees of severity. The gold standard treatment for SVAs consists of complete replacement of the aortic root and valve. However, in certain cases, valve-sparing procedures may prove to be a more suitable alternative.

Case presentation: A 68-year-old male patient presented with dyspnea as symptom caused by a large (> 5 cm) right sinus of Valsalva aneurysm. The aneurysm was occupying most of the right ventricle and was associated with severe aortic regurgitation. The surgical treatment of the condition involved valve-sparing root reconstruction procedure (remodeling technique), completed with external stabilization of the aortic valve annulus via running suture annuloplasty. Following the uneventful intervention, the patient did well and his status improved. The follow-up transthoracic echocardiography obtained 1 month after surgery showed a fully competent aortic valve with no regurgitation.

Conclusions: Despite complete aortic root and valve replacement being considered the safest approach to large SVAs complicated with aortic insufficiency, valve-sparing procedures should not be overlooked in case of a dilated aortic root with uncalcified aortic valve. Performing valve-sparing by applying a remodeling technique operation completed with annuloplasty reduces aortic valve insufficiency, avoiding side-effects related to implanted valves.

Keywords: Aortic root remodeling, case report; Cardiac surgery; Suture annuloplasty; Valsalva aneurysm; Valve-sparing procedure.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Computed tomography angiography. a – Transverse section showing the origin of the SVA from the right aortic cusp, occupying most of the right ventricle (yellow line) which is visible in this incidence as a thin zone around the aneurysm (red line). b – Sagittal section showing the diameters of the aortic valve and aortic root at the level of the sinuses of Valsalva. SVA = sinus of Valsalva aneurysm; Ao = aorta; LV = left ventricle; RV = right ventricle
Fig. 2
Fig. 2
Intraoperative pictures. a – Image showing the orifice of the SVA (marked with asterisk) and the dilated aortic root. b – Hegar dilator is placed in the orifice of the aneurysm. The image is meant to emphasise the size of the aneurysm, here compared to the size of the 25 mm Hegar dilator which was also used for the suture annuloplasty [16]
Fig. 3
Fig. 3
Intraoperative view of the implanted vascular graft, after the exclusion of the aneurysm and the plasty of the aortic valve
Fig. 4
Fig. 4
Volume rendering of the CTA scan indicating the SVA in brown colour within the right ventricle in blue
See this image and copyright information in PMC

References

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