Aneurysmal dilation less commonly affects the left sinus and rupture into the right atrium is still rarer and a chronic insidious presentation as in this case is odd. [ncbi.nlm.nih.gov]

Approximately 5–10% of patients present with acute endocarditis. 3 In the present case, there was no such precipitating cause for the sudden rupture. Conventionally, surgical repair of the RSVA has been the mainstay of therapy. [invasivecardiology.com]

Presentation varies from asymptomatic findings to acute heart failure, which can rapidly worsen to cause death. [casereports.bmj.com]

• Asymptomatic

  Presentation varies from asymptomatic findings to acute heart failure, which can rapidly worsen to cause death. [casereports.bmj.com]

  The patient was asymptomatic and in her 4th month of pregnancy. Transthoracic echocardiography revealed a ruptured sinus of Valsalva aneurysm and a fistula to the right ventricle with evidence of a continuous left-to-right shunt. [ncbi.nlm.nih.gov]

• Coarctation of the Aorta

  […] of the aorta have also been previously published. 6-8 Another with a closely related condition, pseudocoarctation, has also been recorded. 9 Two new cases of coarctation of the aorta with aneurysmal dilatation of the aortic sinuses are herein described [annals.org]

  It can coexists with other malformations such as ventricular septal defect, anomalies of the aortic valve and coarctation of the aorta [3,4,9]. [medcraveonline.com]

• Swelling

  Symptoms often include acute chest pain, pain in the right upper quadrant, cough, difficulty breathing, swelling in the legs, and decreased urine output. [nmcheartcare.ae]

  He was having orthopnoea and paroxysmal nocturnal dyspnoea and swelling of the feet. His vitals were stable with pulse rate 96/min, blood pressure 130/50 mm Hg, and respiratory rate 14/min. [medcraveonline.com]

  However, depending on the size, growth rate, and location of these abnormalities, they can cause pain in the jaw, neck, chest, or back; swelling in the arms, neck, or head; difficult or painful swallowing; hoarseness; shortness of breath; wheezing; a [icdlist.com]

  Hinge line of aortic leaflet separates aneurysm from VSD Supracristal VSD & RSOVA Incomplete fusion of the truncal swellings at the time of the division of the common truncus from the bulbar septum during the 5th week of embryogenesis 17. [slideshare.net]

• Surgical Procedure

  A good prognosis depends on early diagnosis and prompt surgical intervention. However, we think the best surgical procedure is modified Button Bental procedure, as we did in our case. [omicsonline.org]

  SVA requires a surgical procedure due to its high risk of mortality in unoperated patients and a good safety of surgery. 1. [ncbi.nlm.nih.gov]

  Preoperative variables and surgical procedures are summarized in Tables 1 and 2, respectively. The study was approved by the Institutional Human Ethics Committee, and all patients gave consent for the procedure. [cardiothoracicsurgery.biomedcentral.com]

• Fever

  A 21-year-old man was admitted to our hospital with a high fever of 2-week duration. On physical examination, a grade 3/6 continuous murmur was heard in the left lower sternal border. [link.springer.com]

  A parturient at 37-week gestation complained of a sore throat and cough that started 3 days before admission, followed 1 day later by fever, dizziness, breathlessness, and palpitation on exertion. [ncbi.nlm.nih.gov]

  Case presentation A 42-year-old man was admitted to the emergency room with severe dyspnea and fever of 1-day duration. When he was 13 years old, he received a diagnosis of VSD. [jtd.amegroups.com]

• Dyspnea

  We report a 27-year-old woman who presented with worsening exertional dyspnea and palpitation. Transthoracic echocardiography showed ventricular septal defect, with left-to-right shunting and mild aortic regurgitation detected. [ncbi.nlm.nih.gov]

  A 30-year-old patient presented to our cardiology clinic with the complaint of dyspnea. [unboundmedicine.com]

  Keywords Aneurysmal dilatation; Sinuses; Aortic; Dyspnea Introduction Since its first description in 1840 by Thurman, varying terminologies and classifications have been used. [omicsonline.org]

• Exertional Dyspnea

  We report a 27-year-old woman who presented with worsening exertional dyspnea and palpitation. Transthoracic echocardiography showed ventricular septal defect, with left-to-right shunting and mild aortic regurgitation detected. [ncbi.nlm.nih.gov]

  dyspnea, fatigue, chest pain and that can lead to congestive heart failure if left untreated. [orpha.net]

  As symptoms, patients may present acute right heart failure, exertional dyspnea, palpitations, and angina like chest pain [ 3 ]. In our patient, symptoms were presented as insufficiency of right ventricle. [omicsonline.org]

  Symptoms typically present in young adulthood (usually in patients Sudden massive rupture may occur after strenuous exertion and may be signaled by acute chest or epigastric pain with dyspnea. [chdbabies.com]

• Abdominal Pain

  It often occurs in retro peritoneum and presents the triad of shock, abdominal or back pain and epigastric pulsatile mass. The shock may be minimal or absent, depending on the degree of initial hemorrhage. [clinicazurbano.com]

  Symptoms can include substernal chest pain, abdominal pain, and mild to severe dyspnea. [ncbi.nlm.nih.gov]

  A 40-year-old woman who went to hospital with acute abdominal pain and hypotension. Ultrasound imaging showed an important hemoperitoneum. [citeulike.org]

• Heart Failure

  Sudden aneurysm rupture can trigger rapidly progressive heart failure. We discuss the case of a 57-year-old woman with situs ambiguus, isolated levocardia, and polysplenia who presented with acute-onset heart failure. [ncbi.nlm.nih.gov]

  Presentation varies from asymptomatic findings to acute heart failure, which can rapidly worsen to cause death. [casereports.bmj.com]

• Heart Disease

  We briefly review the association between congenital heart disease, situs ambiguus, and ciliary dysfunction. [ncbi.nlm.nih.gov]

  University of Medicine, Silesian Center for Heart Diseases, Zabrze, Poland b Computed Tomography Department, Silesian University of Medicine, Silesian Center for Heart Diseases, Zabrze, Poland Keywords Catheterization. [revespcardiol.org]

  Larger defects may cause symptoms of shortness of breath and volume overload of the heart. Surgical repair is indicated but requires expertise in the repair of congenital heart disease. [columbiacardiology.org]

• Continuous Murmur

  Patients with a coronary aneurysm alone do not generally exhibit continuous murmurs; however, murmurs may be detected in the presence of a fistula. [ncbi.nlm.nih.gov]

  On physical examination, a grade 3/6 continuous murmur was heard in the left lower sternal border. [link.springer.com]

  The diagnostic work-up for a pre-cordial continuous murmur mostly consists of echocardiography. [ecrjournal.com]

• Diastolic Murmur

  His physical examination revealed a thrill localized in the 5th intercostal space on the right edge of the sternum and systolic-diastolic murmur beginning from the aortic focus and spreading to the neck and back along the right edge of the sternum. [unboundmedicine.com]

  On auscultation, a grade 4/6 early diastolic murmur was heard over the left lower sternal border and Erb's area with a thrill. Crepitating rales were heard over bilateral basal lung fields. [ncbi.nlm.nih.gov]

  The boy suddenly developed acute prechordal pain, symptoms of low heart output and systolic-diastolic murmur. The diagnosis of ruptured aneurysm of the sinus of Valsalva was based on echocardiography. [analesdepediatria.org]

  The heart rate was regular, and systolic and diastolic murmurs were heard over the right sternal border. [jtd.amegroups.com]

  Physical signs may include the following: A loud continuous murmur, accentuated in the diastole, occurs with aneurysm rupture into the right ventricle or right atrium. [chdbabies.com]

• Heart Murmur

  We report the case of a 35-year-old pregnant woman who presented at the hospital for cardiac evaluation due to the presence of a heart murmur. The patient was asymptomatic and in her 4th month of pregnancy. [ncbi.nlm.nih.gov]

  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]

• Confusion

  The frequent presence of tricuspid valve tissue or a prolapsed AV leaflet trapped within a VSD can look like a “windsock” and further cause confusion. In our patient, the small size of the aneurysm made the “windsock” difficult to visualize. [journals.lww.com]

  Symptoms may be confused with those of acute myocardial infarction. [chdbabies.com]

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]

The conventional treatment of RSVA is surgical repair under cardio-pulmonary bypass (CPB) or percutaneous catheter closure. [ncbi.nlm.nih.gov]

Although the classical treatment method of ruptured SVA is surgical repair, percutaneous closure devices may be used as a reliable alternative method in suitable patients. [unboundmedicine.com]

Discussion: Surgical treatment for ruptured sinus of Valsalva aneurysm is safe and has satisfactory results. [thieme-connect.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]

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]

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]

Treatment and prognosis Surgical repair with a Bentall procedure can be performed. [radiopaedia.org]

A good prognosis depends on early diagnosis and prompt surgical intervention. However, we think the best surgical procedure is modified Button Bental procedure, as we did in our case. [omicsonline.org]

Discussion was made on the etiology and differential diagnosis. [ncbi.nlm.nih.gov]

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]

The present report is the first to describe a familial unruptured coronary sinus of Valsalva aneurysm raising questions regarding the screening of relatives of patients with sinus of Valsalva aneurysms of unknown etiology. [onlinecjc.ca]

Root replacement or Ross procedure maybe used if severe local septic etiology. Complications Rupture into RV > RA > LV > IVS/PA leads to formation intracardiac fistulae or tamponade. [pie.med.utoronto.ca]

This case is unusual because of the patient's young age at presentation, the absence of predisposing factors, and the isolation of a nonvaccine serotype 21, which revealed the epidemiologic changes of invasive pneumococcal disease. [ncbi.nlm.nih.gov]

In Ophthalmic Epidemiology, Vol. 16 (2009), 15-21 Abstract Purpose: To estimate the prevalence of dry eye and to investigate its relationship with lifestyle and systemic factors in a general adult population in north-western Spain. [citeulike.org]

The association of aneurysm with hypertension and smoking, as well as local atheromatous degenerative changes, coronary and cerebral atherosclerotic etiology simultaneously support, but the controversy is served after the publication of several epidemiological [clinicazurbano.com]

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]

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]

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]

There is a higher reported incidence in Asian groups.[8][9] Pathophysiology Non-ruptured sinus of Valsalva aneurysm is usually asymptomatic. [ncbi.nlm.nih.gov]

An early aggressive approach is recommended to prevent worsening symptoms and more extensive disease. [ncbi.nlm.nih.gov]