Isolated unruptured sinus of Valsalva aneurysm producing right ventricular outflow obstruction

An unusual case of right ventricular outflow obstruction and right heart failure due to an isolated unruptured congenital sinus of Valsalva aneurysm originating from the right coronary sinus in a 75-year-old-man is described. The diagnosis was made by two-dimensional echocardiography and cardiac catheterization. Successful surgical resection of the aneurysm resulted in dramatic symptomatic improvement.     

Three-dimensional transesophageal echocardiographic delineation of ventricular septal aneurysm producing right ventricular outflow obstruction in an adult

We report three-dimensional echocardiographic delineation of a congenital aneurysm of the membranous interventricular septum causing right ventricular outflow tract obstruction in an adult patient. To our knowledge, these findings have not been described before.     

Conduit-integration in correction of right ventricular outflow obstruction

A new method for correction of right ventricular flow tract obstruction is described. The method combines the advantages of patch-plasty-procedure and external valved conduit by conduit integration into the right ventricular and pulmonary arterial wall. Good results had been achieved in 3 cases (2 cases of Fallot's tetralogy and one case of double outlet right ventricle).     

Leiomyosarcoma--an unusual cause of right ventricular outflow tract obstruction

A 76-year-old female patient was admitted with progressive dyspnea on exertion, signs of right ventricular failure, and severe pulmonary stenosis. Intraoperatively an infiltrating right ventricular outflow tract (RVOT) tumor was found and xenograft conduit replacement was performed successfully. Histological examination revealed primary cardiac leiomyosarcoma, the patient was discharged and is in good health condition at 9 months' follow-up. Unusual causes of RVOT obstruction should be considered.     

Intravascular stent prosthesis for right ventricular outflow obstruction.

OBJECTIVES. This study was designed to assess the impact of implantation of balloon-expandable stents on right ventricular outflow obstruction in children with congenital heart disease. BACKGROUND. Intravascular stenting has been established as a useful treatment in adults with coronary and peripheral vascular disease. Its application in the treatment of infants and children with pulmonary, systemic and right ventricular conduit obstruction resistant to balloon angioplasty is limited. METHODS. A total of 24 stainless steel stents were implanted in 17 patients. Five stents were placed within right ventricular to pulmonary artery conduits, 17 in branch pulmonary arteries and 1 in an aortopulmonary collateral vessel. Follow-up time has ranged from 1 to 14 months, with 6 patients having hemodynamic and angiographic studies greater than 1 year after stent placement. The mean age at implantation was 7.4 +/- 5.6 years and the mean weight 33 +/- 16 kg. RESULTS. Optimal stent position was obtained in 22 of 24 implantations. In one patient the stent slipped from the delivery balloon and was left positioned in the inferior vena cava. No embolization or thrombotic event has been documented. Among patients with right ventricular to pulmonary artery conduit obstruction, the gradient was immediately reduced from 85 +/- 30 mm Hg to 35 +/- 20 mm Hg after stent implantation; however, three patients required conduit replacement because of persistent obstruction with elevated right ventricular pressures (82 +/- 16 mm Hg). In 10 of 11 patients with pulmonary artery stenosis, clinical improvement was noted in association with enlargement of vessel diameter by 92% +/- 90% (range 17% to 355%) and the gradient reduction of 22 +/- 24 mm Hg to 3 +/- 4 mm Hg. CONCLUSIONS. These data support the view that intravascular stenting will become an important adjunct in the management of children with congenital heart disease.     

Double aortic arch system producing obstruction to left ventricular outflow

The occurrence of a double aortic arch system with intracardiac defects is unusual. Clinical recognition may be difficult in the absence of upper airway obstruction. This report describes the diagnosis and surgical management of an infant with Interruption of the ventral left arch and hypoplasia of the dorsal right arch who presented with evidence of pulmonary and systemic venous congestion caused by obstruction to left ventricular outflow and a large left to right ventricular shunt.     

Unruptured sinus of Valsalva aneurysm with right ventricular outflow obstruction

The recommended operative management of unruptured sinus of Valsalva aneurysm consists of closure of the mouth of the aneurysm with or without aortic valve surgery. We report a case of unruptured aneurysm producing right ventricular outflow tract obstruction. Closure of the mouth of the aneurysm failed to relieve the obstruction, which was subsequently achieved by excising the aneurysmal wall overlying the outflow tract.