engleski

Valsalva sinus aneurysm

Objective: Valsalva sinus aneurysm (VSA) is an uncommon anomaly, usually caused by congenital deficiency in the aortic media, while rarely develops due to previous surgery or infection. VSA appears three times more often in males and is usually diagnosed in the third or fourth decade of life. Frequently it is combined with other heart anomalies (aortic coarctation, bicuspid aortic valve, VSD). Its main complication is a spontaneous rupture into adjacent cardiac chambers. Also, VSA may cause aortic insufficiency due to distortion of normal coronary sinus anatomy. Methods: in six patients with VSA clinical picture, ECG, related anomalies, previous surgery, transthoracic/transesophageal echocardiography, cardiac cataterisation findings and type of surgery were analyzed. Results: Between 1999-2007 VSA was found in 6 patients (2 men, 4 women, average age 44.7 years, range 18-75 years). Five patients had exertional dyspnea, one olso a new continuous murmur. The sixth asymptomatic patient had only new continuous murmur. Two patients had previous surgery (isthmoplasty due to aortic coarctation, mitrale valve replacement). Five patients had sinus rhythm, one atrial fibrillation. One patient had ECG signs of left ventricle hypertrophy and one a left bundle branch block. Echocardiography revealed aneurysm of noncoronary sinus in five patients and in one aneurysm of right coronary sinus. Aneurysms were from 22 mm x 19 mm to 51 mm x 40 mm in size. In two cases VSA rupture was found, one into the right atrium and other into the right ventricle, with a shunt of 23% and 46% of pulmonary circulation, respectively. All patients had aortic insufficiency, two 2+ and four 3+. Three patients had patent foramen ovale and two ascendent aorta aneurysm. Three patients underwent surgery. In one transatrial resection of VSA and aortic valve replacement were performed. The other two underwent a modified Bentall procedure with implantation of conduit and aortic prosthesis. Three patients were not surgically treated (one refused surgery, second returned to the institution where he was earlier treated, third died before surgery due to pulmonary embolism). Conclusion: The major complication of VSA is the rupture into heart chambers, usually into the right atrium or right ventricle. The consequence of the rupture is a sudden appearance of left-to-right shunt and acute volume loading of both right and left heart chambers and the risk of endocarditis. Therefore surgical correction is indicated in all patients with VSA. Related anomalies make the procedure often technically complicated.

sinus of Valsalva; aneurysm; ruptured aneurysm; aortic valve insufficiency; echocardiography

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