The case of the diagnosis and successful surgical treatment of a giant sinus of Valsalva aneurysm

Abstract

Sinus of Valsalva aneurysm is rare cardiac anomaly. The most common cause of a sinus of Valsalva aneurysms is congenital, although they may also be acquired. Unruptured aneurysms are usually asymptomatic and found incidentally during diagnostic studies. More commonly, aneurysm of sinus of Valsalva is detected after the occurrence of rupture. Rupture of the aneurysm, where it usually occurs in the right atrium, can cause acute symptoms of heart failure. In this case report, the typical echocardiographic images, cardiac catheterization and CT results of a patient with ruptured sinus of Valsalva aneurysm. A 47-year-old female was referred to our institution with a 5 month history of dyspnea on slight exertion, swelling of limbs, orthopnea. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) showed in the cavity of the right atrium above the tricuspid valve additional round echo-signal, with the presence of turbulent systolic and diastolic flow in it, creating a dynamic obstruction of the right atrioventricular orifice (foreing body?). Cardiac catheterization, including thoracic aortography, and computed tomography yielded a large (25 × 21 × 30 mm) right sinus of Valsalva aneurysm with signs of shunting into the right atrium. The diagnosis was confirmed. The patient underwent surgery for the repair of the aortic root and was discharged on the tenth day. In this clinical case data of the echocardiography was not enough for diagnosis. Sinus of Valsalva aneurysm simulates a foreign body of the right atrium. Only radiologic studies have helped to put the correct diagnosis. Surgical treatment is a safe and reliable method for correcting a rare anomaly of the aortic root – sinus of Valsalva aneurysm.