Project description:BackgroundRuptured sinus of Valsalva (SOV) is a rare cardiac anomaly with poor prognosis if untreated. Early diagnosis with accurate delineation of its anatomy is critical for timely treatment and choice of surgical vs. percutaneous intervention. Here we report a case of fistulous rupture of SOV; the preoperative multimodality studies including echocardiography, cardiac magnetic resonance and cardiac catheterization provided teaching and learning points.Case summaryA 48-year-old man with history of heart murmur and hypertension presented with a 5-day history of shortness of breath and peripheral oedema. He was diagnosed with rapid atrial flutter. The transthoracic and transesophageal echocardiography showed severe biventricular systolic dysfunction with a left-to-right shunt from ruptured SOV. The colour Doppler by transthoracic and transesophageal echocardiography and cardiac magnetic resonance revealed a swaying shunt flow exiting in direction to the right atrium (RA) and basal right ventricle (RV) during systole and diastole with no myocardial scaring. The left and right heart catheterization showed elevated right-sided pressures, pulmonary capillary wedge pressure, and left ventricular end-diastolic pressure. There was no difference in O2 saturation between venae cavae and RA but a misleading step-up in O2 saturation between RA and RV. Owing to rupture anatomy with uncertainty, the patient underwent surgical intervention. The ruptured SOV tunnelled through the base of tricuspid annulus to the RA very close to the basal RV.DiscussionEven with multimodality studies it can still be challenging to delineate the anatomy of a ruptured SOV without uncertainty preoperatively.

| S-EPMC9356725 | biostudies-literature

Multimodality Imaging in Giant Ascending Aortic Aneurysm.

Project description: Not available

| S-EPMC6470066 | biostudies-literature

Dissecting aneurysm of sinus of Valsalva into interventricular septum and rupturing into left ventricle through multiple sinuses: a rare case report.

Project description:BackgroundRuptured sinus of Valsalva (RSOV) is a rare disorder, which usually involves the right coronary sinus (RCS) or the non-coronary sinus (NCS) and ruptures usually into the right-sided chambers. Involvement of the left coronary sinus (LCS) and multiple sinuses, rupture into the left ventricle (LV), and dissecting aneurysm of the interventricular septum (IVS) have all been scarcely reported.Case summaryA 24-year-old male presented with complaints of exertional fatigue, palpitations, and chest pain with signs of aortic run-off like wide pulse pressure, collapsing pulse along with cardiomegaly, and a diastolic murmur. Echocardiography revealed sinus of Valsalva aneurysms (SOVAs) involving both the RCS and LCS with RCS aneurysm dissecting the IVS and rupturing into the LV and another multilobulated aneurysm from LCS rupturing into the LV. Findings were confirmed on computed tomography (CT) aortogram, and the patient underwent successful surgical repair.DiscussionSinus of Valsalva aneurysm is a rare disorder which usually ruptures into the right-sided chambers. The involvement of multiple sinuses and rupture into the IVS is extremely rare (<2%). Aneurysm dissecting the IVS can lead to complete heart block (CHB) and sudden death. Involvement of the LCS is reported in <5% cases of RSOV, and rupture of such an aneurysm into the pericardial space may lead to cardiac tamponade and can also lead to sudden death. Clinical examination, electrocardiogram, chest X-ray, 2D echocardiography, and CT all help in the diagnosis. Treatment involves surgical repair of the defect.

| S-EPMC11350371 | biostudies-literature

Case Report: Multimodality Imaging as a Lifeline for Fatal Localization of Valsalva Sinus Fibroelastoma.

Project description:Background: Papillary fibroelastomas are rare benign heart tumors, and is most likely to involve the cardiac valves. We will present an extremely rare localization of a large Valsalva sinus fibroelastoma, with occasional left coronary artery ostial obstruction presented as an acute coronary syndrome. The tumor was removed surgically and histologically confirmed as papillary fibroelastoma. This review points to the crucial importance of multidisciplinary team decision and multimodality imaging methods for diagnosing the fibroelastoma, determination of size, and localization, which avoided complications of fatal embolization during an invasive procedure. Case Summary: A healthy 55-year-old male with vigorous physical daily training and exercise was admitted to the acute coronary syndrome emergency department. Shortly after admission, expert transthoracic echocardiography was performed. Computed tomography of the chest observed a large irregular hypodense tumor-like lesion in the bulbar aorta that was occasionally prolapsing into the left main coronary artery ostium and which corresponded to fibroelastoma. A few hours after admission, an emergency cardiac surgery was performed with the excision of a Valsalva sinus tumor (size 2 × 2 cm) located between the right and left coronary cusp of the aortic valve. Conclusions: Focus cardiac ultrasound should be performed for any acute coronary syndrome because of the possible Valsalva sinus fibroelastoma etiology. Its localization next to the left main coronary artery ostium is rare, and dangerous. The timely diagnosis can be made by the multimodality imaging method, however, the final diagnosis will be made pathohistologically. Early cardiac surgery may be a necessitated recourse for these patients in order to prevent a fatal outcome.

| S-EPMC8200485 | biostudies-literature

Unruptured sinus of Valsalva aneurysms - Multimodality imaging correlation helps determine indications and approaches for repair.

Project description:Despite conventional advice to watch-and-wait, unruptured sinus of Valsalva aneurysms (SOVA) of the non-coronary sinus may produce symptoms that prompt corrective surgery early. A case of a 51-year-old man is illustrated. He presented with shortness of breath and on and off chest pains, was noted to have a large SOVA of non-coronary sinus (NCC), compressing the left atrium with risk of systemic embolism due to presence of spontaneous echocardiography contrast with early thrombus formation. Coronary angiogram, computed tomography of the aorta and 3D echocardiography demonstrated anatomic and physiological correlations. These helped guide corrective surgery. No perioperative complications were encountered, and the patient was symptomatically better following surgery. Multi-modality imaging was crucial to understand the approach and the need for early repair of the SOVA of NCC successfully.Learning objectives1)Unruptured sinus of Valsalva aneurysms of non-coronary sinus can cause substantial clinical risks to patients, as identifiable with multi-modality imaging.2)Early surgical repair guided by imaging, with preservation of aortic valve anatomy appears a reasonable strategy in such patients.

| S-EPMC9508633 | biostudies-literature

Quadricuspid pulmonic valve and great pulmonary artery aneurysm by multimodality imaging.

Project description: Not available

| S-EPMC8114650 | biostudies-literature

A multimodality approach to a rare case of ruptured sinus of Valsalva aneurysm with tricuspid valve involvement: a case report

Project description: Not available

| S-EPMC10516659 | biostudies-literature

Multimodality Imaging of a Giant Circumflex Coronary Artery Aneurysm in a Septuagenarian.

Project description: Not available

| S-EPMC7451935 | biostudies-literature

Giant Aneurysm of the Right Coronary Artery: Multimodality Imaging and Interventional Management.

Project description:A large (40-mm) circular structure in the right atrioventricular groove was detected by transthoracic echocardiography and was diagnosed as a giant aneurysm of the right coronary artery. Through invasive mapping by a guide extension catheter, the aneurysm could be excluded by implantation of 3 overlapping stent grafts. (Level of Difficulty: Beginner.).

| S-EPMC8311151 | biostudies-literature

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