Multilobulated Sinus of Valsalva Aneurysm Dissecting into the Interventricular Septum (DAIS) and Rupturing into Left Ventricle: A Case Report.
Computed tomography (CT) angiography
Dissecting aneurysm of the interventricular septum (DAIS)
Echocardiography
Rupture of the sinus of Valsalva
Sinus of Valsalva aneurysm
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
03
12
2021
accepted:
03
02
2022
entrez:
2
3
2022
pubmed:
3
3
2022
medline:
3
3
2022
Statut:
epublish
Résumé
Dissecting aneurysm of sinus of Valsalva (SOV) into the interventricular septum is a rare entity. Multilobulated form of dissection rupturing into the left ventricle (LV) has never been reported in the literature. A 52-year-old male presented with dyspnoea and palpitation with wide pulse pressure and peripheral signs of distal run-off and a continuous murmur along the left parasternal area. Echocardiography revealed dilated right coronary cusp (RCC), which burrowed into the interventricular septum (IVS), forming multi-loculated cystic lesion which ruptured into LV with associated restrictive ventricular septal defect (VSD) and severe aortic regurgitation. Computed tomography (CT) angiography confirmed a 4.8 cm × 5.3 cm × 5.4 cm multiseptated aneurysm. The surgery involved excision of the aortic valve (AV) with the sinus, ligation of its penetrating portion at the crest of IVS, closure of VSD, and AV replacement. Postoperative echocardiography showed the complete collapse of the IVS component of the SOV aneurysm and the normally functioning mechanical AV. Dissecting aneurysm into the IVS is a rare variant of SOV aneurysm, usually arising from RCC. It is mostly congenital in origin and has wide variety of presentations like congestive heart failure, palpitations, recurrent syncope, chest pain, sudden cardiac arrest, infective endocarditis, cerebral infarction, or asymptomatic. Aortic regurgitation is present in 30-50% of cases. Conduction disturbances from first-degree block to complete heart block are common. Echocardiogram, CT angio, and magnetic resonance imaging are useful for diagnosis. Surgical repair is the only option for treatment.
Sections du résumé
BACKGROUND
BACKGROUND
Dissecting aneurysm of sinus of Valsalva (SOV) into the interventricular septum is a rare entity. Multilobulated form of dissection rupturing into the left ventricle (LV) has never been reported in the literature.
CASE SUMMARY
METHODS
A 52-year-old male presented with dyspnoea and palpitation with wide pulse pressure and peripheral signs of distal run-off and a continuous murmur along the left parasternal area. Echocardiography revealed dilated right coronary cusp (RCC), which burrowed into the interventricular septum (IVS), forming multi-loculated cystic lesion which ruptured into LV with associated restrictive ventricular septal defect (VSD) and severe aortic regurgitation. Computed tomography (CT) angiography confirmed a 4.8 cm × 5.3 cm × 5.4 cm multiseptated aneurysm. The surgery involved excision of the aortic valve (AV) with the sinus, ligation of its penetrating portion at the crest of IVS, closure of VSD, and AV replacement. Postoperative echocardiography showed the complete collapse of the IVS component of the SOV aneurysm and the normally functioning mechanical AV.
DISCUSSION
CONCLUSIONS
Dissecting aneurysm into the IVS is a rare variant of SOV aneurysm, usually arising from RCC. It is mostly congenital in origin and has wide variety of presentations like congestive heart failure, palpitations, recurrent syncope, chest pain, sudden cardiac arrest, infective endocarditis, cerebral infarction, or asymptomatic. Aortic regurgitation is present in 30-50% of cases. Conduction disturbances from first-degree block to complete heart block are common. Echocardiogram, CT angio, and magnetic resonance imaging are useful for diagnosis. Surgical repair is the only option for treatment.
Identifiants
pubmed: 35233482
doi: 10.1093/ehjcr/ytac019
pii: ytac019
pmc: PMC8874869
doi:
Types de publication
Case Reports
Langues
eng
Pagination
ytac019Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
Cardiology. 2006;106(2):73-81
pubmed: 16612073
Clin Cardiol. 2015 Mar;38(3):185-9
pubmed: 25757442
Indian Heart J. 1989 Sep-Oct;41(5):330-4
pubmed: 2599545
Am Heart J. 1949 May;37(6):975-81
pubmed: 18119903
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2006;:165-76
pubmed: 16638563
J Cardiovasc Comput Tomogr. 2009 Mar-Apr;3(2):122-36
pubmed: 19272853
Ann Thorac Surg. 1998 Mar;65(3):735-40
pubmed: 9527204
J Comput Assist Tomogr. 1995 Jul-Aug;19(4):652-6
pubmed: 7622705
Cardiol Young. 2017 Apr;27(3):609-612
pubmed: 27873570
J Thorac Cardiovasc Surg. 1976 Jun;71(6):839-45
pubmed: 1271834
Eur Heart J Case Rep. 2020 May 26;4(3):1-5
pubmed: 32617459