Ruptured Aneurysm of the Non-Coronary Sinus of Valsalva
From the Departments of Cardiology and *Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
The authors report no financial relationships or conflicts of interest regarding the content herein.
Manuscript submitted November 10, 2008, provisional acceptance given December 30, 2008, final version accepted January 7, 2009.
Address for correspondence: Abdullah Mohammed, MB ChB, MRCP, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE United Kingdom. E-mail: firstname.lastname@example.org
Case Presentation. A 35-year-old female presented with a 6-month history of dizziness, palpitations and sweating. A continuous precordial murmur was audible. Transthoracic echocardiography (TTE) showed abnormal flow between the aortic root and the right atrium (RA) with significant aortic regurgitation. Aortography and transesophageal echocardiography (TEE) confirmed the presence of a ruptured non-coronary sinus of Valsalva aneurysm (SVA) with a fistula to the right atrium. The findings were confirmed during a successful surgical repair which included aortic valve replacement (Figure 1).
Discussion. The non-coronary sinus is involved in less than 15% of patients with congenital SVA. Congenital SVA is often unrecognized until it ruptures, usually in the third or fourth decade, causing acute chest pain, syncope or cardiac failure.1 When a non-coronary sinus aneurysm ruptures, it forms a fistula to the RA in 10% of patients. Cardiac catheterization and aortography, magnetic resonance imaging, 2-dimensional TTE and multiplane TEE are all useful in providing anatomical information to aid transcatheter or surgical management.2
1. Takach TJ, Reul GJ, Duncan JM, et al. Sinus of Valsalva aneurysm or fistula: Management and outcome. Ann Thorac Surg 1999;68:1573–1577.
2. Baur LH, Vleigen HW, ven der Wall EE, et al. Imaging of an aneurysm of the sinus of Valsalva with transesophageal echocardiography, contrast angiography and MRI. Int J Card Imaging 2000;16:35–41.