Unruptured noncoronary sinus of Valsalva aneurysm: preoperative characterization by transesophageal echocardiography.

We describe a patient with a large unruptured sinus of Valsalva aneurysm that was discovered incidentally. Transesophageal echocardiography was used to characterize the aneurysm preoperatively, and was helpful intraoperatively in assessment of the degree of native aortic valvular regurgitation after repair. The use of transthoracic echocardiography, contrast echocardiography, Doppler echocardiography, and transesophageal echocardiography are discussed in this condition.     

Valsalva窦瘤破裂的超声诊断价值与分析

目的 探讨Valsalva窦瘤破裂及合并畸形的超声表现与临床诊断价值.方法 回顾性分析我院62例,Valsalva窦瘤并破裂患者的临床资料,将超声检查结果 与手术结果 对照.结果 62例患者中,术前超声诊断Valsalva窦瘤破裂58例(符合率93.5%),误诊为法洛四联症、三尖瓣反流各1例(3.2%),漏诊2例(3.2%);常见的合并畸形有干下室间隔缺损(33例,53.2%)、主动脉瓣发育不良伴重度主动脉瓣关闭不全(11例,17.7%);超声报告窦瘤部位及破人腔室与手术结果 一致,超声所测室间隔缺损大小明显低于手术所见.结论 超声心动图对Valsalva窦瘤破裂的部位、破人心腔及主要合并畸形的诊断与鉴别诊断具有较大的价值.     

Multi-slice CT demonstration of sinus of Valsalva rupture

Aneurysms of the sinus of Valsalva are rare. We report here the case of a 56-year-old man with a ruptured aneurysm of sinus of Valsalva with flow into the right ventricle which was diagnosed non-invasively by 64-row multi-slice computed tomographic (CT) imaging. The right sinus of Valsalva aneurysm rupturing into the right ventricular outflow region might be silent or symptomless in many cases. The patient also had mild symptom. For anatomical demonstration, contrast-enhanced CT was performed. Although the ruptured sinus of Valsalva was initially diagnosed by echocardiography, CT images did give our surgeons a better three-dimensional appreciation when surgical repair was performed. Multi-slice CT imaging should be considered the technique of choice for both diagnosis and follow-up examination of the aneurysm of sinus of Valsalva and its rupture.     

主动脉窦瘤破裂的外科处理对策

目的探讨总结主动脉窦瘤破裂的不同类型,及其合并症的外科处理对策及治疗效果。方法回顾性分析1999年12月至2009年8月,32例主动脉窦瘤破裂的病人,均在体外循环下进行外科手术治疗,合并其他畸形同期矫治。其中14例（43.7%）合并室间隔缺损,2例（6.2%）合并主动脉瓣关闭不全并同期进行主动脉瓣置换,1例合并主动脉瓣关闭不全并同期进行主动脉瓣成形。结果全组手术过程顺利无死亡,术后随访3个月至8年心功能（NYHA分级）均恢复到Ⅰ~Ⅱ级。结论主动脉窦瘤破裂一经确诊应早日手术,使用补片修补缺损手术效果满意,预后良好。同时矫正合并的心脏畸形可获得良好的近远期效果。     

Successful catheter ablation of atrial tachycardia originating near the atrioventricular node from the noncoronary sinus of Valsalva

This report describes a patient who underwent RF catheter ablation of atrial tachycardia. Two applications of RF energy near the His-bundle region transiently terminated the tachycardia. With detailed mapping at the aortic sinus of Valsalva using a retrograde transaortic approach, the earliest atrial activation was found in the noncoronary sinus of Valsalva. Complete elimination of the tachycardia was achieved with RF energy application from this site.     

超声诊断乏式窦瘤破裂伴室间隔缺损1例

患者女,45岁,2年前出现活动后心累,1个月前症状加重,自诉口唇稍发绀,无胸闷、胸痛。体格检查:颈静脉无怒张,心率75次/min,心界稍向左下扩大,于胸骨左缘第三、四肋间闻及Ⅳ级全收缩期连续性杂音伴震颤。经胸超声心动图检查:左室及双房内径均增大;室间隔上份(紧邻主动脉瓣右冠瓣,大动脉短轴约11点)可探及连续性回声中断,宽约3 mm。右冠窦窦壁呈“囊袋”状凸入右室流出道,顶端破口约5 mm(图1),Sakakibara分类Ⅱ型;CDFI及频谱多普勒示右冠窦血流分流入右室流出道,分流信号为双期连续性;室间隔回声中断处探及收缩期左向右血流信号,伴少量三尖瓣反流及二尖瓣轻度脱垂(图2,3)。     

超声心动图在经导管封堵主动脉窦瘤破裂中的应用价值

目的 探讨超声心动图评价经导管封堵主动脉窦瘤破裂疗效的应用价值.方法 对11例行经导管封堵主动脉窦瘤破裂患者的超声心动图进行回顾分析.评价术前窦瘤破口的位置、形态、大小等,术中监测封堵器置入,术后随访评价其疗效.结果 11例患者术前超声诊断均为单纯主动脉窦瘤破裂,超声测得破口直径2～13 mm.11例患者均封堵成功,10例采用动脉导管封堵器,型号较破口直径大约1～5 mm.3例患者术后即刻少量残余分流于术后1月内复查消失,其中1例患者术后32月随访时再次出现少量残余分流;所有患者未见主动脉瓣反流加重等并发症.结论 经导管封堵主动脉窦瘤破裂是治疗主动脉窦瘤破裂安全有效的方法,远期疗效需进一步观察,超声心动图在其中发挥重要作用.

Abstract：

Objective To evaluate the value of echocardiography in transcatheter closure of ruptured sinus of Valsalva aneurysm(TC-RSVA).Methods TC-RSVA was attempted in 11 patients.The location,shape,size of defects and its relationship with the neighbor structures were revealed before the procedure.Then the deployment of occluder was monitored during the procedure,and the effectiveness was observed in the follow-up.Results Eleven patients were diagnosed as the isolated RSVA by echocardiography.The size of defects was 2 - 13 mm estimated by echo.The procedures were successful in all patients.Usually the Amplatzer duct occluders were chosen to be 1 to 5 mm larger than the size of defects.Three patients had mild residual shunt during the procedure,which all dispeared in the first month of follow-up,but one of them demonstrated recurrent mild residual shunt in the 32nd month of follow-up.There was no aggravating aortic regurgitation in the follow-up.Conclusions TC-RSVA is relatively safe and effective.Observation of long-term effectiveness is still necessary.Echocardiagraphy plays an important role in TC-RSVA.     

超声心动图在经导管封堵主动脉窦瘤破裂中的应用价值

目的 探讨超声心动图评价经导管封堵主动脉窦瘤破裂疗效的应用价值.方法 对11例行经导管封堵主动脉窦瘤破裂患者的超声心动图进行回顾分析.评价术前窦瘤破口的位置、形态、大小等,术中监测封堵器置入,术后随访评价其疗效.结果 11例患者术前超声诊断均为单纯主动脉窦瘤破裂,超声测得破口直径2～13 mm.11例患者均封堵成功,10例采用动脉导管封堵器,型号较破口直径大约1～5 mm.3例患者术后即刻少量残余分流于术后1月内复查消失,其中1例患者术后32月随访时再次出现少量残余分流;所有患者未见主动脉瓣反流加重等并发症.结论 经导管封堵主动脉窦瘤破裂是治疗主动脉窦瘤破裂安全有效的方法,远期疗效需进一步观察,超声心动图在其中发挥重要作用.     

Unusual clinical course after surgical repair of unruptured aneurysm of sinus of Valsalva

Aneurysms of the sinus of Valsalva are characterized by dilatation of at least one of the three aortic sinuses. We experienced a case with unruptured aneurysm of the right sinus of Valsalva, in which serial imaging studies were useful in assessing a rare complication after surgical repair. An asymptomatic 75-year-old man underwent patch closure of the aneurysm orifice because of progressive enlargement of the aneurysm. The postoperative course was uneventful, and computed tomography (CT), performed a week after the patch repair, showed no leakage of contrast medium into the isolated aneurysm. Three months later, echocardiography showed decreased size of the aneurysm with heterogeneous echogenicity and possible blood flow in the aneurysm, findings suggestive of thrombus formation and a recurrent fistula. CT with contrast medium showed partial recanalization between the patched aneurysm and the right sinus of Valsalva. Follow-up echocardiography, performed 1 year after surgery, revealed neither definite aneurysm nor shunt flow of Valsalva. The present case highlights that non-invasive follow-up can be an alternative option when carried out with caution in selected patients with incomplete closure of Valsalva aneurysm.     

Ruptured sinus of Valsalva aneurysm in two patients with subarterial ventricular septal defect

Summary Rupture of a sinus of Valsalva aneurysm (SVA) is a rare, but life–threatening, event and requires immediate recognition and intervention. We present two previously healthy and physically active patients who were 12 and 33 years of age when rupture of a right coronary SVA into the right ventricle occurred. A subarterial ventricular septal defect (VSD) was detectable in both patients. Cardiac surgery involved VSD closure as well as reconstruction of the aortic valve. Considering complications of subarterial VSD, such as aortic cusp prolapse, aortic insufficiency or SVA, we suggest close follow–up and surgical closure of the VSD in case of any aortic valve deformity.