Simultaneous Aortic and Tricuspid Valve Endocarditis due to Complication of Sinus of Valsalva Rupture

We experienced a case of ruptured aneurysm of the sinus of Valsalva, and this resulted in simultaneous aortic and tricuspid valve endocarditis through a shunt. The echocardiography showed a ruptured sinus of Valsalva aneurysm to the right atrium with a shunt. The aortic non-coronary cusp was fibro-thickened with vegetation. Vegetations of the septal leaflet and the anterior leaflet of the tricuspid valve were also found. The blood culture grew Enterococcus garllinarum. We replaced both tricuspid and aortic valve with successful surgical result.     

Ruptured aneurysms of sinus of Valsalva with bicuspid aortic valve--a case report of an aged patient (72 years old)

A 72-year-old man with ruptured aneurysms of the sinus of Valsalva and a bicuspid aortic valve was operated. Ruptured aneurysms were found in the noncoronary sinus region, and they were opened to the commissure between the anterior cusp and septal cusp of the tricuspid valve. The tissue around the aneurysm was very weak, so closure of the ruptured hole was carried out from the inside of both aorta and right atrium. Ruptured aneurysm of Valsalva is very rare in a aged patient. In this case, it is considered that the bicuspid aortic valve associated with malformations of the aortic cusp caused a weakness of the sinus wall, and this region gradually became aneurysmal.     

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.     

Aorto-right atrial fistula associated with native tricuspid valve endocarditis

Abnormal connections between the ascending aorta and the cardiac chambers are rare. Most are due to ruptured aneurysms of the sinus of Valsalva. Congenital fistulae between the aorta and left atrium are described. We report a case of native tricuspid valve endocarditis associated with a fistula between the right atrium and the aorta.     

Pulmonary valve endocarditis caused by right ventricular outflow obstruction in association with sinus of valsalva aneurysm: a case report

Background  

Right-sided infective endocarditis is uncommon. This is primarily seen in patients with intravenous drug use, pacemaker or central venous lines, or congenital heart disease. The vast majority of cases involve the tricuspid valve. Isolated pulmonary valve endocarditis is extremely rare. We report the first case of a pulmonary valve nonbacterial thrombotic endocarditis caused by right ventricular outlflow tract (RVOT) obstruction in association with a large sinus of Valsalva aneurysm.     

Ruptured congenital aneurysm of the sinus of Valsalva: surgical technique and long-term follow-up.

Congenital ruptured aneurysm of the sinus of Valsalva is a rare anomaly usually causing decrease of cardiac performance. Eight patients with a ruptured congenital aneurysm of the sinus of Valsalva were operated upon at the University Hospital Zurich between 1970 and 1991. There were four female and four male patients aged from 15 to 48 years (mean, 36 years). Three patients were asymptomatic and five symptomatic. Associated congenital cardiac defects were found in six patients. Surgical techniques consisted of direct suture in seven patients and closure with a Dacron patch in one. A secondary Dacron patch closure was performed on the second postoperative day in a patient with suture insufficiency after direct closure. Associated operations were closure of ventricular septal defect in two patients, aortic valve replacement in two, aortic valve reconstruction in one and aortic valve commissurotomy in one patient. There were no operative deaths. The mean follow-up was 9 years, range 7 months to 17 years. There were two late deaths due to endocarditis and recurrent cerebral embolisation. An operation for a ruptured aneurysm of the sinus of Valsalva has a low operative risk, but patients remain prone to development of late valvular complications.     

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.     

Ruptured sinus of a Valsalva aneurysm associated with autosomal-dominant polycystic kidney disease in an elderly patient: Report of a case

We report herein the case of a 71-year-old woman with autosomal-dominant polycystic kidney disease (ADPKD), who was referred to our hospital for investigation of facial edema. Echocardiography demonstrated a large aneurysm arising from the noncoronary sinus of Valsalva, with a left to right shunt and jets of blood passing from the aneurysm toward the septal leaflet of the tricuspid valve. Surgical treatment was successfully carried out by resecting the aneurysmal wall and performing a patch closure of the orifice. It is well known that ADPKD predisposes patients to cardiovascular disease, and this case report serves to demonstrate that when a patient with ADPKD presents with progressive heart failure, the possibility of a ruptured sinus of a Valsalva aneurysm must be considered. Received: March 1, 1999 / Accepted: March 24, 2000     

主动脉窦瘤破裂的外科治疗及远期疗效

目的 总结主动脉窦瘤破裂的临床特点及外科疗效,讨论对合并感染性心内膜炎及主动脉瓣关闭不全患者的处理.方法 回顾性分析1997年9月至2007年9月43例主动脉窦瘤破裂患者的临床资料.其中男性32例,女性11例;年龄11～50岁,平均年龄(29.0±11.5)岁.破口源于右冠状动脉窦34例,无冠状动脉窦9例.破入有心室30例,右心房8例,右心室及右心房3例,破人室间隔2例.合并室间隔缺损26例,主动脉瓣关闭不全15例,感染性心内膜炎8例,三尖瓣反流6例,房间隔缺损4例,二尖瓣反流2例,动脉导管未闭2例,肺动脉赘牛物1例.全部患者于心肺转流下行窦瘤修补及合并畸形矫治术.结果 无围手术期死亡.并发症5例,包括急性左心功能衰竭3例,Ⅲ度房室传导阻滞2例.随访6～120个月,平均(68.0±17.7)个月;2例分别于术后第6、8年行主动脉瓣置换术,2例进展为Ⅱ级主动脉瓣父闭小全.结论 主动脉窦瘤破裂外科治疗可获得满意效果.对合并主动脉瓣关闭小全及感染性心内膜炎的患者应早期手术,积极防治术后并发症并长期随访.     

Coronary arterial compression caused by an aneurysm of the sinus of Valsalva with aortic prosthetic valve endocarditis

Myocardial ischemia caused by coronary arterial compression by an aneurysm of the sinus of Valsalva is a particularly unusual complication. We describe a patient with aortic prosthetic valve endocarditis complicated with an aneurysm of the sinus of Valsalva. An 82-year-old woman was admitted to our hospital with a high fever and chest discomfort. She had undergone aortic valve replacement 3?years earlier. Computed tomography showed an aneurysm originating from the left and right aortic sinus that was compressing the proximal left anterior descending coronary artery. The aortic root was successfully replaced and antibiotic treatment was continued for 6?weeks after surgery.     

A case report of aortic valve replacement following ruptured aneurysm of the sinus of valsalva with bicuspid valve

Only three cases of the combination of bicuspid aortic valve and ruptured aneurysm of the sinus of Valsalva, associated with previously repaired coarctation of aorta, have been reported. A twenty-year-old man with a sudden onset of CHF due to ruptured aneurysm of the sinus of Valsalva underwent intracardiac repair by direct closure of the sinus Valsalva in combination with patch closure of a subarterial VSD. Although, no AR was detected preoperatively, massive reguratitation occurred after the repair due to subsequent failure of aortic valve coaptation in the present of the bicuspid aortic valve, which was not diagnosed preoperatively. Aortic valve replacement with SJM 25 mm was successfully performed.     

Adult aortic coarctation discovered incidentally after the rupture of sinus of Valsalva aneurysm: combined surgical and interventional approach

Combination of ruptured sinus of Valsalva aneurysm (SVA), and a coexisting asymptomatic adult aortic isthmic coarctation is extremely rare. The timing and sequence of surgical and/or interventional repair of these two pathologies are controversial. We present a case of a 37-year-old male who was admitted to our department because of severe acute congestive heart failure and signs of ruptured aneurysm of the SV into the right ventricle. Transthoracic and transoesophageal echocardiography confirmed the communication between an important right coronary SVA and right ventricle, bicuspid aortic valve, mild aortic regurgitation, and revealed severe aortic coarctation. Because of the severe dilation of right sinus of Valsalva a surgical repair of the ruptured aneurysm was performed. Aortic coarctation was treated four weeks later by a percutaneous stent-graft implantation. This case report supports the concept that hybrid approach is feasible in patients with ruptured SVA and aortic coarctation in adulthood.     

Surgical repair of ruptured aortic sinus of Valsalva aneurysm

Surgical repair of ruptured aortic sinus of Valsalva aneurysm was performed on six patients. The NYHA functional class was I in one case, II in three and III in two cases. All aneurysms had ruptured into the right atrium. Three originated from the right, and three from the non-coronary aortic sinus of Valsalva. The preoperative shunt was 55-200% (mean 118%) of the peripheral cardiac output. At aneurysmal repair, closure of secundum-type atrial septal defect was performed in one case and insertion of a St Jude Medical aortic valve in another. There were no perioperative deaths. Five patients were asymptomatic in the follow-up period (5 months-17 years). One patient died of cardiomyopathy 11 years postoperatively. The long-term results after surgical repair of ruptured aortic sinus of Valsalva aneurysm thus were good, and early operation is recommended in order to avoid congestive heart failure.     

Management of Anomalous Left Circumflex Artery Encircling the Aortic Annulus in a Patient Undergoing Multivalvular Surgery

Abstract   The abnormal origin of left circumflex artery from the right sinus of Valsalva with a retroaortic course is a well-known coronary anomaly usually without consequences. In patients undergoing aortic valve replacement, this finding becomes crucial because the left circumflex is at risk of injury during the procedure. The scenario is even more complex in patients undergoing multi-valve surgery. We report the diagnosis and successful operative strategy in a patient with anomalous left circumflex arising from the proximal right sinus of Valsalva undergoing double aortic and tricuspid valve surgery for active bacterial endocarditis.     

Urgent aortic valve replacement in disseminated gonococcaemia associated with sinus of Valsalva aneurysm and fistula formation.

A patient with aortic valve disruption due to gonococcal endocarditis and associated with a sinus of Valsalva aneurysm and fistula into the right ventricle is described. The rarity of this combination of conditions and the place of surgery in their management are discussed.     

A case report of successful repair for ruptured aneurysm of sinus of Valsalva (I VSD) with aortic regurgitation

A nineteen-year-old female who had history of infectious endocarditis underwent surgical repair for ruptured aneurysm of sinus of Valsalva with aortic regurgitation. Through aortotomy mild degree of prolapse of right coronary cusp and perforation of left coronary cusp sized 6 mm in diameter were recognized and the latter was thought to be the dominant lesion resulting in severe aortic regurgitation. Following direct closure of ruptured aneurysm and patch closure of ventricular septal defect, perforated left coronary cusp was repaired with autologous pericardium. Post operative course was uneventful and she is now doing well.     

URGENT AORTIC VALVE REPLACEMENT IN DISSEMINATED GONOCOCCEMIA ASSOCIATED WITH SINUS OF VALSALVA ANEURYSM and FISTULA FORMATION

A patient with aortic valve disruption due to gonococcal endocarditis and associated with a sinus of Valsalva aneurysm and fistula into the right ventricle is described. The rarity of this combination of conditions and the place of surgery in their management are discussed.     

Surgical repair of a sinus of a Valsalva aneurysm ruptured into the left ventricle

A 47-year-old man presented with orthopnea. He had no infection or, in particular, infectious endocarditis. An echocardiogram and multislice computed tomography scan revealed a left sinus of Valsalva aneurysm (SVA) that had ruptured into the left ventricle, with severe aortic regurgitation. He was diagnosed with ruptured congenital SVA with severe aortic regurgitation and underwent closure of the aneurysmal mouth with a Dacron patch, and concomitant aortic valve replacement. The use of a Dacron patch to close the aneurysmal mouth of a ruptured congenital left SVA has not been reported previously in the medical literature.     

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.     

Austrian triad with sinus of Valsalva aneurysm and rupture

An interesting case of a young patient presenting with Austrian's Triad: pneumococcal pneumonia, pneumococcal meningitis, and pneumococcal endocarditis. On echocardiogram the patient was noted to have a noncoronary sinus of Valsalva aneurysm and vegetations on the aortic cusps resulting in disruption of valvular integrity and severe aortic insufficiency. Color Doppler also revealed rupture of the aneurysm into the right atrium. The patient was taken to surgery where the noncoronary cusp was noted to be completely replaced with vegetative lesions. The aortic valve was replaced with a No. 21 Carpentier-Edwards bioprosthetic valve (Edwards Lifesciences, Irvine, CA), and the noncoronary sinus of Valsalva was repaired with concomitant closure of the fistula using glutaraldehyde autologous pericardium.