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Sinus of valsalva aneurysm with fistula to the right atrium presented as acute heart failure in a young man.

Ibrahim KS, Waqfi NR, Jarrah MI - Am J Case Rep (2013)

Bottom Line: ECG showed ischemic changes.Diagnosis of AMI was made, but auscultation revealed a murmur followed by a TTE and TEE, which revealed a ruptured sinus of valsalva aneurysm.The optimal management for a ruptured SVA is surgical repair, with an acceptably low operative risk and good long-term outcome.

View Article: PubMed Central - PubMed

Affiliation: Jordan University of Science and Technology, General Surgery, Irbid, Jordan.

ABSTRACT

Patient: Male, 23 FINAL DIAGNOSIS: Sinus of valsalva aneurysm (SVA) Symptoms: Chest pain • low O2 saturation • short of breath

Medication: - Clinical Procedure: - Specialty: Cardiology.

Objective: Rare disease.

Background: Sinus of valsalva aneurysm (SVA) is a rare cardiac anomaly. It may be congenital or acquired; a coexisting cardiac lesion might be present. Rupture of the aneurysm, where it usually occurs in the right atrium, can cause acute symptoms of heart failure. Echocardiography (particularly TEE) can provide all necessary diagnostic data for safe surgical treatment. Treatment of choice is surgery.

Case report: A 23-year-old male, previously healthy, presented to the emergency room (ER) with shortness of breath for the last 10 hours after lifting a heavy object. The patient had central chest pain. His O2 sat was 88%. ECG showed ischemic changes. Diagnosis of AMI was made, but auscultation revealed a murmur followed by a TTE and TEE, which revealed a ruptured sinus of valsalva aneurysm.

Conclusions: This case report highlights the superiority of TEE over TTE in diagnosis and in planning adequate surgical treatment for patients with ruptured SVA, as well as the importance of ultrasonographer experience in the diagnosis. The optimal management for a ruptured SVA is surgical repair, with an acceptably low operative risk and good long-term outcome.

No MeSH data available.


Related in: MedlinePlus

TEE showing the non-coronary sinus with aneurysmal dilatation and rupture (fistulization) to the right atrium (arrow): RA – Right Atrium, AA – Aortic Valve area, NCC – Non-Coronary Cusp of the aortic valve.
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f3-amjcaserep-14-398: TEE showing the non-coronary sinus with aneurysmal dilatation and rupture (fistulization) to the right atrium (arrow): RA – Right Atrium, AA – Aortic Valve area, NCC – Non-Coronary Cusp of the aortic valve.

Mentions: A 23-year-old male, previously healthy, presented to the emergency room (ER) with shortness of breath for the last 10 hours after lifting a heavy object. The patient had central chest pain, palpitation, nausea, and vomiting. On examination, his blood pressure (Bp) was 115/55 mmHg, heart rate (HR) was 125–150 bpm, and respiratory rate was 25/min. Pulse oximeter measured an oxygen (O2) saturation of 88%. Chest X-ray showed congestion of both lung fields (Figure 1), with normal heart size. Electrocardiogram (ECG) (Figure 2) showed left ventricular (LV) strain and ST depression in lateral leads. Serum troponin was positive. A provisional diagnosis of acute myocardial infarction (MI) was made. However, a diastolic murmur was heard with difficulty because of the rapid heart rate. TTE was not conclusive, but it showed grade I mitral valve regurgitation (MR), grade II aortic valve regurgitation (AR), and a pulmonary artery pressure (PAP) of 70 mmHg. TEE showed acute AR grade III–IV, possible a ruptured non-coronary cusp with fistula formation to the right atrium (Figure 3) and possible type A aortic dissection starting at the non-coronary sinus. These findings were confirmed in the operating room. Surgery included a composite mechanical graft and repair of the right atrium.


Sinus of valsalva aneurysm with fistula to the right atrium presented as acute heart failure in a young man.

Ibrahim KS, Waqfi NR, Jarrah MI - Am J Case Rep (2013)

TEE showing the non-coronary sinus with aneurysmal dilatation and rupture (fistulization) to the right atrium (arrow): RA – Right Atrium, AA – Aortic Valve area, NCC – Non-Coronary Cusp of the aortic valve.
© Copyright Policy
Related In: Results  -  Collection

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f3-amjcaserep-14-398: TEE showing the non-coronary sinus with aneurysmal dilatation and rupture (fistulization) to the right atrium (arrow): RA – Right Atrium, AA – Aortic Valve area, NCC – Non-Coronary Cusp of the aortic valve.
Mentions: A 23-year-old male, previously healthy, presented to the emergency room (ER) with shortness of breath for the last 10 hours after lifting a heavy object. The patient had central chest pain, palpitation, nausea, and vomiting. On examination, his blood pressure (Bp) was 115/55 mmHg, heart rate (HR) was 125–150 bpm, and respiratory rate was 25/min. Pulse oximeter measured an oxygen (O2) saturation of 88%. Chest X-ray showed congestion of both lung fields (Figure 1), with normal heart size. Electrocardiogram (ECG) (Figure 2) showed left ventricular (LV) strain and ST depression in lateral leads. Serum troponin was positive. A provisional diagnosis of acute myocardial infarction (MI) was made. However, a diastolic murmur was heard with difficulty because of the rapid heart rate. TTE was not conclusive, but it showed grade I mitral valve regurgitation (MR), grade II aortic valve regurgitation (AR), and a pulmonary artery pressure (PAP) of 70 mmHg. TEE showed acute AR grade III–IV, possible a ruptured non-coronary cusp with fistula formation to the right atrium (Figure 3) and possible type A aortic dissection starting at the non-coronary sinus. These findings were confirmed in the operating room. Surgery included a composite mechanical graft and repair of the right atrium.

Bottom Line: ECG showed ischemic changes.Diagnosis of AMI was made, but auscultation revealed a murmur followed by a TTE and TEE, which revealed a ruptured sinus of valsalva aneurysm.The optimal management for a ruptured SVA is surgical repair, with an acceptably low operative risk and good long-term outcome.

View Article: PubMed Central - PubMed

Affiliation: Jordan University of Science and Technology, General Surgery, Irbid, Jordan.

ABSTRACT

Patient: Male, 23 FINAL DIAGNOSIS: Sinus of valsalva aneurysm (SVA) Symptoms: Chest pain • low O2 saturation • short of breath

Medication: - Clinical Procedure: - Specialty: Cardiology.

Objective: Rare disease.

Background: Sinus of valsalva aneurysm (SVA) is a rare cardiac anomaly. It may be congenital or acquired; a coexisting cardiac lesion might be present. Rupture of the aneurysm, where it usually occurs in the right atrium, can cause acute symptoms of heart failure. Echocardiography (particularly TEE) can provide all necessary diagnostic data for safe surgical treatment. Treatment of choice is surgery.

Case report: A 23-year-old male, previously healthy, presented to the emergency room (ER) with shortness of breath for the last 10 hours after lifting a heavy object. The patient had central chest pain. His O2 sat was 88%. ECG showed ischemic changes. Diagnosis of AMI was made, but auscultation revealed a murmur followed by a TTE and TEE, which revealed a ruptured sinus of valsalva aneurysm.

Conclusions: This case report highlights the superiority of TEE over TTE in diagnosis and in planning adequate surgical treatment for patients with ruptured SVA, as well as the importance of ultrasonographer experience in the diagnosis. The optimal management for a ruptured SVA is surgical repair, with an acceptably low operative risk and good long-term outcome.

No MeSH data available.


Related in: MedlinePlus