Abstract
Introduction: Sinus of Valsalva aneurysm (SVA) is an abnormal dilation of one or more aortic sinuses located between the aortic valve annulus and the sinotubular junction. SVA rupture can cause shunting into cardiac chambers creating hemodynamic compromise and has a high morbidity and mortality requiring prompt recognition and treatment.
Case presentation: A 62-year-old male with past medical history of heart failure, COPD, hypertension, hyperlipidemia, schizophrenia, and dementia, presented with a two-day onset of shortness of breath. BNP was elevated and chest X-ray showed bilateral pleural effusions and volume overload. The patient had a TTE (transthoracic echocardiogram) performed on May 2023 which showed normal ejection fraction, diastolic flattening of ventricular septum consistent with RV volume and pressure overload; atrial shunt, moderate TR, moderate free-flowing pericardial effusion; systolic pulmonary artery pressure of 77 mmHg. TEE (transesophageal echocardiogram) was performed and showed a small right-to-left atrial level shunt, a ruptured non-coronary sinus of Valsalva aneurysm into the right atrium with continuous systolic and diastolic left to right shunt on spectral and color Doppler interrogation. During the hospitalization TTE was obtained which re-demonstrated the aneurysmal dilation of the noncoronary sinus of Valsalva with protrusion into the right atrium, associated with rupture and shunting into the right atrium. Patient underwent repair of sinus of Valsalva aneurysm with fistula to right atrium using bovine pericardium patch, repair of atrial septal defect as well as coronary artery bypass grafting and was ultimately discharged.
Conclusion: A ruptured sinus of Valsalva aneurysm is a rare condition which can cause heart failure with volume overload as well hemodynamic compromise. This condition has high morbidity and mortality, therefore must be promptly identified, and treated surgically.
Keywords
Sinus of Valsalva aneurysm, Rupture, Atrial shunt, Echocardiography