Large Unruptured Sinus of Valsalva Aneurysm Dissecting into Interventricular Septum and Presenting as a Complex Myocardial Cystic Mass

Unruptured aneurysm of sinus of Valsalva (SOV) is extremely rare. They may be asymptomatic and diagnosed incidentally or can present with either fatal outcome following rupture or manifest acutely with compression of surrounding structures. Dissection of unruptured aneurysm of left SOV into interventricular septum (IVS) and presenting as intramyocardial mass is not reported in the literature. We are reporting a case of 21‐year‐old man who was referred to us following a seizure episode and was incidentally diagnosed with aneurysm of left SOV dissecting into IVS. Multimodality imaging confirmed the diagnosis. He successfully underwent surgical repair and was asymptomatic during follow‐up.     

Two Different Presentations of Sinus of Valsalva Aneurysm

Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that can be congenital or acquired. We report 2 cases of SVA. The first case involves a 59‐year‐old male presenting with frequent syncope. Echocardiogram revealed a large right SVA obstructing the right ventricular outflow tract (RVOT). The second case involves a 21‐year‐old female presenting with sudden onset chest pain and a continuous machinery murmur. Echocardiogram revealed a ruptured right SVA into the right atrium. Although advanced percutaneous techniques have been implemented in the correction of this anomaly, open‐heart surgery with or without aortic valve replacement remains the treatment of choice.     

Severe Right Ventricular Outflow Obstruction by Right Sinus of Valsalva Aneurysm

Aneurysms of the sinus of Valsalva are rarely diagnosed cardiac anomalies, occurring in 0.14%–0.96% of patients who have undergone open heart surgical procedures. The most common congenital anomalies accompanying sinus of Valsalva aneurysm (SVA) are ventricular septal defect, bicuspid aortic valve, atrial septal defect, and coarctation of aorta. We report a patient with an unruptured right SVA presenting with severe right ventricular outflow tract (RVOT) obstruction, and coexisting patent foramen ovale (PFO) with a right to left shunt. It could be assumed that the increase in right atrial pressure due to RVOT obstruction had led to a right to left shunt across the patent foramen ovale. (Echocardiography 2010;27:341‐343)     

Atrial Septal Aneurysm and Dilated Sinus of Valsalva in a Patient with Wolff-Parkinson-White Syndrome

Atrial septal aneurysm and a dilated sinus of Valsalva were noted on echocardiography in a 30-year-old male with Wolff-Parkinson-White syndrome. The relative low probability of all three coexisting by chance alone suggests the possibility of a common developmental origin.     

Bad Company: Supracristal VSD Presenting with Ruptured Sinus of Valsalva Aneurysm. A Case Presentation with Echocardiographic Depiction and an Analysis of Contemporary Literature

Supracristal ventricular septal defect (SCVSD), a defect of the infundibular portion of the interventricular septum just below the right aortic cusp, occurs more frequently in Eastern Asian populations. SCVSD may be complicated by right sinus of Valsalva aneurysm (SoVA). We present the case of a 26‐year‐old male of Korean descent with a history of a childhood murmur who was referred to our institution for progressive heart failure symptoms. He was diagnosed with SCVSD and ruptured right SoVA based on history, physical exam, and echocardiography including three‐dimensional transesophageal echocardiography with reconstructed surgical views. The patient underwent SCVSD closure, SoVA excision, and valve‐sparing aortic root replacement. We reviewed the echocardiography literature regarding SCVSD and SoVA, and analyzed contemporary literature of SoVA and its relationship with SCVSD. We conclude that a higher prevalence of ruptured SoVA in Eastern Asians is likely related to a higher prevalence of underlying SCVSD in this population.     

Rupture of a Noncoronary Sinus of Valsalva Aneurysm into the Left Atrium: A Rare Cause of Acute Pulmonary Edema

A sinus of Valsalva aneurysm is a dilatation of the aortic wall caused by the lack of continuity between the middle layer of the aortic wall and the aortic valve. It has an incidence of <0.1%. The most common cause of a sinus of Valsalva aneurysms is congenital, although they may also be acquired. The most common complication is rupture into the right atrium or ventricle, with rupture into the left chambers occurring very rarely. We present a 40‐year‐old man admitted to the hospital with an acute onset of respiratory distress and pleuritic chest pain. Transthoracic echocardiography followed by transesophageal echocardiography showed rupture of a noncoronary aneurysm of Valsalva sinus into the left atrium. The jet from the fistula caused retrograde flow into the pulmonary veins.     

Transesophageal Echocardiographic Detection of Sinus of Valsalva Dissection

We describe a left sinus of Valsalva dissection diagnosed by transesophageal echocardiography and confirmed at surgery. A dissection of the left sinus of Valsalva has not been previously reported.     

Sinus of Valsalva Aneurysm—An Unusual Cause of Syncope

Sinus of Valsalva aneurysms (SOVA) are rare anomalies which often only become apparent at the time of rupture. Syncope associated with unruptured aneurysms is a recognized symptom but in most previously reported cases the mechanism has been either a brady‐ or tachyarrhythmia. We report a case of a large SOVA affecting the right coronary cusp which presented with syncope secondary to hypotension thought to be resulting from reduced left atrial filling as a consequence of transient right ventricular outflow tract (RVOT) obstruction. The case demonstrates how echocardiographic and angiographic images correlate and also an unusual mechanism of syncope. SOVA are rare anomalies that often only become apparent at the time of rupture. Syncope associated with unruptured aneurysms is a recognized symptom but in most previously reported cases the mechanism has been either a brady‐ or tachyarrhythmia. We report a case of a large SOVA affecting the right coronary cusp, which presented with syncope secondary to hypotension thought to be resulting from reduced left atrial filling as a consequence of transient RVOT obstruction. The case demonstrates how echocardiographic and angiographic images correlate and also an unusual mechanism of syncope. (Echocardiography 2010;27:E60‐E61)     

Real Time Three‐Dimensional Transthoracic Echocardiography of Ruptured Left Sinus of Valsalva Aneurysm to Left Ventricle

Aneurysms arising from the sinus of Valsalva are a rare cardiac defect that can present with various signs and symptoms, and if not diagnosed and treated rapidly can lead to fatal outcomes. 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. Echocardiography has become the investigative tool of choice for this condition, not only for diagnosis but also for quantification of severity. We hereby report a rare case of a 15‐year‐old patient presenting with complaints of effort dyspnea and palpitations. Two‐dimensional transthoracic echocardiography (TTE) showed aneurysmal dilatation of left sinus of Valsalva which had ruptured into the left ventricle. Also, there was an intimal flap within the sinus of Valsalva aneurysm. The anatomical relationship between the aorta, aneurysm, and the left ventricle as well as the intimal flap within the aneurysm was clearly delineated with the help of three‐dimensional TTE. After confirmation of the diagnosis with multidetector computed tomography, patient underwent successful surgical repair of the defect.