A case of two-chambered right ventricle complicating infective endocarditis and tricuspid regurgitation

A 31-year-old male of two-chambered right ventricle with ventricular septal defect, complicating infective endocarditis and tricuspid regurgitation, was presented. Two-dimensional echocardiographic study demonstrated tricuspid vegetations and a hypertrophied, anomalous muscle bundle in the right ventricle. Cardiac catheterization revealed 58 mmHg pressure gradient between inflow chamber and outflow chamber of the right ventricle. It seems that tricuspid regurgitation was resulted from infective endocarditis. He underwent resection of anomalous muscle bundle, repair of ventricular septal defect, and tricuspid valve replacement with satisfactory result. It has not been reported in Japan so far that tricuspid valve replacement was performed for the treatment of tricuspid regurgitation due to infective endocarditis in the patient with two-chambered right ventricle. In our case, cardiac catheterization was performed after subsidence of infective endocarditis. As echocardiography can detect vegetations and anomalous muscle bundle precisely, surgical intervention would be performed without cardiac catheterization in the case of infective endocarditis intractable to medical therapy.     

A case of ruptured aneurysm of the sinus of Valsalva with bacterial endocarditis

A 21-year-old male with ruptured aneurysm of sinus of Valsalva caused by bacterial endocarditis is presented. The patient complained of palpitation and a attack of fever. Continuous murmur was heard with a thrill at the third intercostal space of the left sternal border. On plain chest x-ray film pulmonary congestion and increase in pulmonary flow were observed. Cardiac catheterization showed step up of oxygen contents at the level of right ventricle and left to right shunt of 36.5%. Aortography demonstrated the aneurysm of the sinus of Valsalva ruptured to right ventricle. The operation was performed by right ventricular approach. Aneurysmal sac was resected and its orifice was closed with mattress sutures. Bacteriological examination at the time of operation revealed Staphylococcus aureus. Postoperative course was uneventful.     

Double chambered right ventricle: surgical experience in a 60-year-old woman

The patients reported as double chambered right ventricle are mainly children. A 60-year-old woman had been pointed out for her systolic cardiac murmur without any symptom. She was admitted to our hospital for her gradual onset of fatigue, lassitude. Cardiac catheterization data revealed a 105 mmHg peak-to-peak gradient within the right ventricular cavity with normal pulmonary pressures [20/5 (12) mmHg]. Right ventricular end-diastolic pressure was 4 mmHg. Right ventriculogram demonstrated double chambered right ventricle. Electrocardiogram showed neither right ventricular hypertrophy nor upright T wave in V3R. In order to release intraventricular pressure gradient and her symptom, the anomalous muscle bundles were resected through both the right atrium and the pulmonary artery. Surgical repair without right ventriculotomy is suitable for such an elder patient with double chambered right ventricle whose ventricular function may decrease.     

Ruptured congenital aneurysm of the sinus of valsalva in the aged

Ruptured aneurysm of the sinus of Valsalva is a rare cardiac lesion. A ruptured aneurysm of the sinus of Valsalva in the right ventricle of a 64-year-old man was successfully repaired. The patient was admitted to the hospital with high fever and chest oppression. Diagnosis was made by two dimensional echocardiography, cardiac catheterization, and cardiac angiography. An aortotomy, main pulmonary arteriotomy, and right ventriculotomy were performed. There was no VSD, and the aneurysm originated from the right coronary sinus, rupturing into the right ventricle inlet portion. The ruptured aneurysm of the sinus of Valsalva was closed with a Dacron patch from inside the aorta. He is doing well after surgery. There was no heart murmur. CTR decreased and pulmonary blood flow fell to a normal value. As far as we know, this patient is the second oldest patient in Japan with surgical repair.     

A case report of surgical repair of ruptured aneurysm of sinus valsalva in aged (84 years old)]

An 84-year-old man with ruptured aneurysm of Valsalva sinus was operated. Diagnosis was made by two dimensional echocardiography, cardiac catheterization, and cardiac angiography. A aneurysm was found at the right-coronary sinus region, and ruptured into the right ventricle. The ruptured aneurysm of sinus Valsalva was repaired with direct closure and Woven patch from inside the right ventricle through the pulmonary valve. This case was defined as congenital because there was no sign of inflammatory or atherosclerotic changes in the aorta, aortic valve and aneurysm. The ruptured aneurysm of sinus Valsalva is very rare in aged patients. As far as we know, this patient is one of the oldest cases who underwent successful surgical repair in this country.     

Ruptured aneurysms of the sinus of Valsalva in Oriental patients

Between 1964 and 1987, a total of 57 cases of ruptured aneurysm of the sinus of Valsalva underwent surgical correction at the National Taiwan University Hospital. This represents 0.96% of all cardiac operations. The origin of ruptured aneurysm of the sinus of Valsalva was the right coronary sinus in 46, the noncoronary sinus in nine, and the left coronary sinus in two. The aneurysms ruptured into the right ventricle in 44, into the right atrium in 11, into the left ventricle in one, and into both the right ventricle and right atrium in one. Associated congenital cardiac anomalies included ventricular septal defect in 30 patients, aortic regurgitation in 20, and infundibular pulmonic stenosis and coarctation of the aorta in one each. Operative death occurred in two patients (3.5%) and one patient had a successful reoperation. The remainder did well following surgery. To compare the differences between Oriental and Western countries in ruptured aneurysm of the sinus of Valsalva, 361 cases (195 Oriental patients versus 166 Western) were collected from the literature. Analyses of these cases revealed that ruptured aneurysm of the sinus of Valsalva in Oriental patients compared with Western series is characterized by a higher incidence (5 times), more aneurysms originating from the right coronary sinus (87.9% versus 63.6%), more aneurysm rupturing into the right ventricle (84.2% versus 56.6%), a higher incidence of association with ventricular septal defect (mainly supracristal) (59.0% versus 34.6%), less incidence of association with other congenital cardiac abnormalities (4.1% versus 21.5%), very few instances of rupturing into cardiac chambers other than the right ventricle and right atrium, and less incidence of occurrence in the extremities of ages (the youngest was 7 years in Oriental patients versus 11 months in the Western series). In other words, ruptured aneurysm of the sinus of Valsalva in Oriental patients is more or less a simple and uniform disease entity in contrast to the more diverse and protean pathologic profiles encountered in Western series. However, both Oriental patient and Western patient series have similar incidences of combination with aortic regurgitation (24.6% versus 20.0%), with 40.4% of Oriental patients and 60.6% of Western patients presenting with intact ventricular septum. Therefore the pathogenetic mechanisms of ruptured aneurysm of the sinus of Valsalva may at the same time contribute to the development of aortic regurgitation.     

室上嵴上室间隔缺损的外科治疗

本文报道５６例室上嵴上室间隔缺损的外科治疗。男３４例，女２２例，年龄３～３９岁。１９例合并主动脉瓣叶脱垂、主动脉瓣关闭不全或佛氏窦瘤破裂。经右房切口修补室缺２例，右室漏斗切口４７例，肺动脉切９７例。直接修补缺损２６例，补片修补３０例。主动脉瓣成形术１例，主动脉瓣置换术５例。５４例全愈出院，死亡２例。作者认为室上嵴上空间隔缺损应尽早手术，以免并发主动脉瓣损害和佛氏窦瘤破裂；中度主动脉瓣关闭不全可行主动脉瓣成形术，采用肺动脉切口优于右室漏斗部切口。     

Double chambered right ventricle in a 62-year-old female: a surgical case report]

A 62-year-old female was admitted with a chief complaint of transient syncope on exertion. Angiography in right ventricle revealed a defect caused by an anomalous muscle bundle and a pressure gradient of 151 mmHg was observed between the two chambers by cardiac catheterization. Resection of the anomalouse muscle bundle was undertaken using a lower median sternotomy starting at the 2nd intercostal space level and through the outflow tract right ventriculotomy. Patch plasty was also undertaken in the outflow tract. Post-operative course was uneventful and pressure gradient had disappeared at the post-operative catheterization. A rare case of DCRV in a 62-year-old patient with a pressure gradient of 151 mmHg in the right ventricle was reported.     

Surgical treatment for an asymptomatic and unruptured sinus of Valsalva aneurysm: report of a case

A 70-year-old male underwent a transthoracic echocardiography as a screening test for hypertension and an unruptured aneurysm was detected in the right sinus of Valsalva. The right sinus of Valsalva aneurysm obstructed the right ventricle outflow tract but he did not have any symptoms. The sinus of Valsalva aneurysm was treated successfully by a patch closure with a bovine pericardial patch.     

Aneurysm of sinus of Valsalva

Aneurysm of sinus of Valsalva is a rare cardiac abnormality with congenital origin in most of the cases. If it is located in the right coronary sinus, it usually ruptures into a right heart chamber and frequently a ventricular septal defect (VSD) coexists with this condition. Early diagnosis and immediate surgical treatment can save the patient's life in most cases. All the 3 cases reported in this series had aneurysm of right sinus of Valsalva with associated VSD and mild degree of aortic regurgitation (AR). Two of the cases ruptured aneurysm into the right ventricle. Trans-esophageal echocardiography was used to confirm the diagnosis and all three showed good results with surgery.     

Ruptured congenital sinus of valsalva aneurysms

BACKGROUND AND AIM OF THE STUDY: Rupture of the sinus of Valsalva is rare, and there is a higher incidence of such rupture in Oriental countries than elsewhere. The objective of this study is to present the pathologic features and the clinical outcome after surgery in such patients. METHODS: Between 1980 and 2001, a total of 17 patients (15 males and 2 females) with ruptured aneurysm of sinus of Valsalva underwent surgical intervention at the Tri-Service General Hospital, Taiwan. Their age ranged from 22 to 59 years with a mean of 33.5 years. These surgical operations made up 0.51% of the total cardiac operations (3305) performed during this period. The medical records were retrospectively reviewed. RESULTS: The origin of the ruptured aneurysm of the sinus of Valsalva was the right coronary sinus in 12 patients, the noncoronary sinus in 4, and the left coronary sinus in one patient. The aneurysms ruptured into the right ventricle in 12 patients, into the right atrium in 3 patients, and into the left ventricle in 2 patients. Associated cardiac anomalies were aortic regurgitation in eight patients, ventricular septal defect in seven, and coronary artery fistula in one patient. There was no early postoperative death and one patient underwent a second operation after aneurysm of the sinus of Valsalva (ASV) relapse. CONCLUSIONS: The operation for a ruptured aneurysm of sinus of Valsalva carries a low operative risk and results in excellent long-term survival after surgical treatment.     

Deformities of pulmonary and aortic annulus 42 years after repair of tetralogy of Fallot

We report an extremely rare case of deformity of the pulmonary sinus of Valsalva with pulmonary valvular stenosis 42 years after a pulmonary annular-sparing operation for tetralogy of Fallot. Aortic regurgitation with deformity of the sinus is also noted. At the previous operation, the right ventricular outflow tract was augmented by a prosthetic subvalvular patch. Through the years, the pulmonary valve and sinus were distorted because the patch was pulled over toward the right ventricle.     

Unruptured aneurysm of the sinus of Valsalva associated with right ventricular outflow tract stenosis; report of a case

A 51-year-old female was referred to our hospital for heart murmur and was diagnosed with right ventricular outflow stenosis by echocardiography. Six years later, follow-up echocardiogram revealed that the stenosis was caused by an aneurysm of the sinus of Valsalva (2 cm in diameter) originated from the right coronary sinus. Resection and patch closure of the aneurysm were carried out under complete cardiopulmonary bypass. The aneurysm was not associated with ventricular septal defect and was categorized as Sakakibara-Konno type I. Postoperative state was uneventful. Systolic murmur disappeared and pressure difference in the right ventricular outflow was normalized.     

Ruptured congenital aneurysm of the sinus of Valsalva. Clinical manifestations, diagnosis, and results of surgical corrections

An experience with the management of 27 cases of ruptured sinus of Valsalva aneurysm is reported from the Bakulev Institute of Cardiovascular Surgery, Moscow. The right coronary sinus was involved in 23 cases and the noncoronary sinus in four cases. Rupture into the right ventricle occurred in 19 cases, whereas eight ruptures entered the right atrium. Twelve patients had a ventricular defect, and 10 patients had aortic regurgitation, requiring leaflet suspension in five patients or valve replacement in five patients. The surgical management and results are presented.     

Case report of right ventricular myxoma

A 14-year-old woman was admitted to our hospital due to heart murmur. Loud systolic murmur at the forth intercostal space was altered its intensity by patient's posture. The chest roentgenogram showed normal cardiovascular silhouette. The electrocardiogram revealed normal sinus rhythm without right bundle branch block. The echocardiography and cineangio-cardiography proved a tumor in the right ventricle. Right heart catheterization showed pressure gradient for 35 mmHg between the right ventricle and the pulmonary artery. At surgery, the tumor was excised with the full thickness of the anterior right ventricular wall. The tumor was cardiac myxoma with 15 g of weight. The patient's postoperative course was uneventful.     

A case of ruptured aneurysm of Valsalva sinus into right atrium with peculiar findings on aortography

A 24-year-old man with ruptured aneurysm of sinus of Valsalva into the right atrium originating from the noncoronary sinus is presented. On aortography through the ascending aorta the right atrium in systolic phase and the right ventricle in diastolic phase were opacified. We considered ruptured aneurysm like a streamer (wind sock) entered into the right ventricle in diastolic phase and into the right atrium in systolic phase. Post-aneurysmectomy course was uneventful, and radiographic examination revealed complete repair of the aneurysm.     

Unruptured Aneurysm of the Sinus of Valsalva Presenting with Thrombosis and Right Ventricular Outflow Obstruction

Abstract A 69‐year‐old asymptomatic man was found to have an unruptured aneurysm of the right coronary sinus of Valsalva with the presence of an intraluminal thrombus. The diagnosis was made by computed tomography and by transthoracic echocardiography. Through an aortic and right ventricular approach, we successfully removed the thrombus and repaired the aneurysm of the sinus of Valsalva.     

Sinus of valsalva aneurysm and ventricular tachycardia during pulmonary artery catheterization

Pulmonary artery catheterization is associated with numerous complications, including serious arrhythmias. We report a case where ventricular tachycardia occurred repeatedly during attempted pulmonary artery catheterization, precluding successful catheterization. Transesophageal echocardiography was used to image the tricuspid valve and right ventricle and revealed a Sinus of Valsalva aneurysm protruding significantly into the right ventricle and obstructing advancement of the pulmonary artery catheter. Our case reveals another identifiable cause of serious arrhythmia during pulmonary artery catheterization and highlights how transesophageal echocardiography can be useful in unanticipated ways during cardiac anesthesia and surgery.     

Two-chambered right ventricle in an elderly patient with anoxic spells

A 53-year-old woman with two-chambered right ventricle and ventricular septal defect (VSD) was treated by VSD closure and resection of the abnormal muscle bundle within the right ventricle. The patient remained asymptomatic only with a heart murmur until the age of 40. Then she became to get tired more easily and presented dyspnea on minimal exercise. And recently, she suffered from cyanosis with anoxic spells, which finally led her to our clinic. Cardiac catheterization showed a high pressure chamber of 110 mmHg and a low pressure chamber of 27 mmHg in the right ventricle; a pressure gradient being 83 mmHg in the right ventricle with bidirectional interventricular shunt. This disorder is rarely found in elderly patients and the natural history for patients who remain asymptomatic are still unknown. To the best of our knowledge, this is the first elderly patient to develop anoxic spells like tetralogy of Fallot and treated surgically. The case is presented here, together with a review of the literature.     

A case of intraventricular septum dissection presenting with aneurysmal dilatation through the outflow track of the left ventricle

A dissecting aneurysm of the intraventricular septum is an extremely rare entity. Most of these aneurysms originate from the right sinus of Valsalva and are believed to result from rupture of a Valsalva sinus aneurysm. Such cases may present with aortic insufficiency, rhythm disorders, ventriculo-septal ischemia and infectious endocarditis. In this article, we present a patient who underwent surgical intervention with a diagnosis of intraventricular septal cyst (hydatid cyst) leading to both a flow gradient through the left ventricle outflow track and dysrhythmia, without any evident dilatation or aneurysm of the sinus of Valsalva.