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Ruptured Sinus of Valsalva

Ruptured Sinus Valsalva


Presentation

  • OBJECTIVES: The aim of the present study was to study the feasibility and approaches to device closure of ruptured sinus of Valsalva (RSOV).[ncbi.nlm.nih.gov]
  • We present a case report of a ruptured sinus of Valsalva aneurysm (SVA) that presented as aortic insufficiency following bacterial endocarditits in a cardiac transplant patient.[ncbi.nlm.nih.gov]
  • In this case report, we present a 54-year-old man with a previous history of alcoholic cirrhosis and chronic renal failure who suffered from a fulminant course of infective endocarditis.[ncbi.nlm.nih.gov]
  • We present a case of a 24-year-old woman who was diagnosed with quadricuspid aortic valve with ruptured sinus of Valsalva. Quadricuspid aortic valve is a rare congenital cardiac anomaly.[ncbi.nlm.nih.gov]
  • Abstract A 30-year-old man presented with fevers and fatigue. Blood cultures grew Streptococcus mitis in 4/4 bottles.[ncbi.nlm.nih.gov]
Rigor
  • Rigorous endocarditis prophylaxis and exercise restriction were advised. Discussion A Rare Cardiac Anomaly A rupture of a sinus of Valsalva is a rare cardiac anomaly, mostly occuring in aneurysmal dilated sinuses.[ecrjournal.com]
Recurrent Infection
  • There was no AR progression, recurrence, infective endocarditis, or device embolization. CONCLUSION: In appropriately selected patients with ruptured SOVA, TCC is an attractive alternative to surgery with encouraging short- and mid-term outcomes.[ncbi.nlm.nih.gov]
Hypoxemia
  • A discreet hepatic cytolysis: aspartate aminotransferase (ALAT/TGO) 45/40/40 UI/l, alanine aminotransferase (ALAT/TGP) 148/135/57 UI/l, gamma-glutamyl transpeptidase (GGT) 91/93/112 UI/l, hypoxemia with respiratory alkalosis.[romanianjournalcardiology.ro]
Right Upper Quadrant Pain
  • We report the case of a 28-years-old man which was referred to hospital due to right upper quadrant pain without irradiation and emphasizing a dynamic dyspnea and fatigue.[romanianjournalcardiology.ro]
Jaundice
  • Case Report A 19-year-old young man had a two-year history of exertional dyspnea, lower limb edema, periodic chest pain, and jaundice. The patient was in NYHA classes II and III with his symptoms progressively worsening over time.[ncbi.nlm.nih.gov]
Heart Murmur
  • We here report the case of a 26 years old pregnant woman who was referred to our cardiac center for the evaluation of a heart murmur.[ncbi.nlm.nih.gov]
  • Full Text A 36-year-old man was referred to our hospital for a recent finding of a heart murmur. He had no relevant medical history except paroxysmal palpitations in the previous three months.[elsevier.pt]
  • Conclusion A rupture of a sinus of Valsalva has to be taken into account in the differential diagnosis of a continuous heart murmur, even though the patient looks healthy and is asymptomatic.[ecrjournal.com]
  • DISCUSSIONS In young patients (mostly male – 4:1 ratio – and middleaged), the ruptured aneurysms of sinus of Valsalva may initially be asymptomatic or may be manifested by acute heart failure with the emergence of new heart murmurs imposing a differential[romanianjournalcardiology.ro]
Normal Stature
  • Concerning the etiologic diagnosis, it was ruled out syphilis (VDRL negative) and Marfan syndrome (no eyes disorder, normal stature, normal fingers)3,4.[romanianjournalcardiology.ro]

Workup

  • Surgery has good reputation having a [2] Transcatheter closure (TCC) of ruptured sinus of Valsalva aneurysm (RSOVA) appears to be a reasonable alternative. [3], [4] A thorough workup of location, size, proximity to neighboring structures, complications[nigjcardiol.org]
Staphylococcus Aureus
  • Blood cultures identified methicillin-sensitive Staphylococcus aureus.[ncbi.nlm.nih.gov]
T Wave Abnormality
  • Electrocardiogram can objectify left/right ventricle hypertrophy and non-specifi c ST segment/ T wave abnormalities. The management of RSVA is guided by clinical and echocardiographical fi ndings.[romanianjournalcardiology.ro]

Treatment

  • OBJECTIVES: Different surgical strategies have been evolved for the surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA) from simple primary closure to patching of the rupture site by a dual chamber approach.[ncbi.nlm.nih.gov]
  • After parenteral antibiotic treatment, the patient went for successful repair of the fistula, with the imaging findings confirmed at surgery.[ncbi.nlm.nih.gov]
  • Surgery used to be the mainstay of treatment of RSOV aneurysm, however, in past few years several reports of transcatheter closure of RSOV have come into light. We report a patient, who underwent device closure with a Duct Occluder device.[ncbi.nlm.nih.gov]
  • The conventional treatment for a ruptured sinus of Valsalva is surgical, although transcatheter approaches have been used increasingly in recent years.[ncbi.nlm.nih.gov]
  • Surgical treatment of ruptured sinus of Valsalva aneurysm has an acceptably low operative risk and good long-term symptom-freedom survival. An early aggressive approach is recommended to prevent worsening symptoms and more extensive disease.[ncbi.nlm.nih.gov]

Prognosis

  • Urgent surgical repair for ruptures aneurysms Many recommend surgical repair of non-ruptures aneurysms as well Complications Rupture (see above) Myocardial infarction Heart block Right ventricular outflow tract obstruction Cardiac tamponade Sudden death Prognosis[learningradiology.com]
  • The prognosis of ruptured SOVA is poor and patients usually succumb to acute cardiac failure [ 2 ]. Early diagnosis and treatment are generally associated with a good outcome.[link.springer.com]
  • Prognosis in patients with a ruptured aneurysm who have not undergone surgical repair may be poor, with survival beyond 1 year uncommon.[chdbabies.com]
  • In case of rupture, prognosis is poor and therefore repair is always required.[ecrjournal.com]

Etiology

  • An anatomic etiology of symptoms may be suspected with heart auscultation (murmur), and diagnosis is made by a routine echocardiogram or, if the patient is suspected of having coronary disease as the etiology of symptoms, an angiogram.[hqmeded-ecg.blogspot.com]
  • Asian countries than in the West. 2 Though acquired aneurysms of the aortic sinus have been described postoperatively 9 as also due to atherosclerosis, 10 the typical saccular shape and location of the aneurysm in our patient suggested a congenital etiology[invasivecardiology.com]
  • Infectious etiologies that weaken elastic tissue and are associated with acquired Sinus of Valsalva aneurysm include syphilis, bacterial endocarditis, and tuberculosis.[ncbi.nlm.nih.gov]
  • Although the etiology of SVA is congenital, generally, a minority of this anomaly could be attributed due to trauma, infection, degeneration, and collagen vascular disease [ 7 , 8 ].[ncbi.nlm.nih.gov]
  • Conclusion Percutaneous closure of ruptured sinus of Valsalva is easier when it's etiology, location, size, distant from coronary artery ostium, distance from aortic valve, neighboring structures, associated congenital defects, and complications are properly[nigjcardiol.org]

Epidemiology

  • Epidemiology The estimated rate of Sinus of Valsalva aneurysm is approximately 0.09% of the general population, based on large autopsy series. SOVAs comprise up to 3.5% of all congenital heart defects.[ncbi.nlm.nih.gov]
  • Cardiac tamponade may occur if the rupture involves the pericardial space. [1] Epidemiology Frequency United States SVA was present in 0.09% of cadavers in a large autopsy series and ranged to 0.14-0.23% in a Western surgical series. [4] Two-dimensional[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Image courtesy of Professor Peter Anderson DVM PhD and published with permission PEIR, University of Alabama at Birmingham, Department of Pathology Sinus of Valsalva Aneurysm: Gross; a beautiful picture of windsock opening of aneurysm[wikidoc.org]
  • Pathophysiology Non-ruptured sinus of Valsalva aneurysm is usually asymptomatic. However, non-ruptured sinus of Valsalva aneurysm can lead to cardiac arrhythmias; atrial fibrillation and complete heart block have both been described.[ncbi.nlm.nih.gov]
  • Associated conditions include: Syphilis Trauma Endocarditis Atherosclerosis Marfans (diffuse dilatation) Uncommon – Ehlers Danlos (other connective tissue disorders), Takayasu arteritis (other vasculitides), post AV replacement Pathophysiology Congenital[pie.med.utoronto.ca]
  • Pathophysiology Aneurysmal dilatation of the sinuses of Valsalva occurs when the aortic media is defective, allowing separation of the media from the aortic annulus fibrosus.[chdbabies.com]
  • […] intracardiac shunting caused by rupture of the SVA into the right side of the heart. [1] Approximately 65-85% of SVAs originate from the right sinus of Valsalva, while SVAs originating from noncoronary (10-30%) and left sinuses ( 5%) are exceedingly rare. [2] Pathophysiology[emedicine.medscape.com]

Prevention

  • An early aggressive approach is recommended to prevent worsening symptoms and more extensive disease.[ncbi.nlm.nih.gov]
  • Device was manipulated and deployed with an angle so as to prevent aortic valve dysfunction. 2010 Wiley-Liss, Inc.[ncbi.nlm.nih.gov]
  • Successful transcatheter closure of all defects was possible thereby preventing the morbidity and mortality associated with a repeat surgery. Copyright 2013 Wiley Periodicals, Inc.[ncbi.nlm.nih.gov]
  • A mean survival period of 3,9 years in patients with untreated ruptured sinus of Valsalva aneurysms has been reported. 1 An early, aggressive approach is recommended to prevent clinical deterioration. 1,2,4,6 Operative procedures include simple plication[ecrjournal.com]

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