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Cardiovascular Disease |

Ruptured Sinus of Valsalva Aneurysm: How Deadly Can It Be?

Khalid Sherani, MD; Hineshkumar Upadhyay, MD; Abhay Vakil, MD; Kelly Cervellione, MS; Sudheer Chauhan, MD; Mohammad Babury, MD
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Jamaica Hospital Medical Center, Jamaica, NY


Chest. 2014;146(4_MeetingAbstracts):112A. doi:10.1378/chest.1991542
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Abstract

SESSION TITLE: Cardiovascular Student/Resident Case Report Posters I

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Ruptured aortic sinus aneurysm, also known as aneurysm of the sinus of valsalva (SVA) has been described as a cause of hemopericardium and cardiac temponade in less than 1% cases. Isolated aneurysms are usually asymptomatic unless complicated by rupture. Most commonly SVA ruptures into the right atrium or ventricle with pericardium being one of the less commonly involved sites. Such ruptures are usually lethal requiring immediate surgical intervention. We report the case of an adult female presenting with sudden-onset chest pain and shock. Examination findings and imaging studies confirmed the presence of hemopericardium. Subsequent autopsy studies confirmed an isolated rupture of SVA.

CASE PRESENTATION: A 50-year-old hypertensive, smoker female presented with sudden onset retrosternal chest pain for 1 hour. She denied any cough, fever, vomiting or recent trauma to the chest wall. On physical examination the patient was in severe distress with hypotension (70/50 mm Hg). Cardiac examination revealed muffled heart sounds with an elevated JVD. Examination of other systems was unremarkable. A 12-lead electrocardiogram showed electrical alterans (Fig. 1). Radiology studies showed bilateral clear lung fields with cardiomegaly (Fig. 2). The patient was treated with aggressive hydration. A bedside echocardiogram followed by emergency pericardiocentesis was being considered. In the meantime, patient developed cardiac arrest. The patient expired despite of aggressive resuscitative measures. Subsequent autopsy confirmed the presence of hemopericardium and an isolated right aortic sinus SVA that ruptured into the pericardium.

DISCUSSION: SVA is an extremely cardiac anomaly with an estimated incidence ranging from 0.1% to 3.5%. Congenital cases are usually associated with other cardiac defects with ventricular septal defect being the most common. Acquired cases are associated with infectious etiologies (syphilis, tuberculosis, endocarditis), trauma and degenerative disorders. Most of the cases remain asymptomatic or present with aortic insufficiency. As ruptured SVA is associated with high mortality, asymptomatic patients diagnosed with such aneurysms should be followed up closely by yearly transesophageal echocardiography. Prophylactic surgical correction is recommended to correct mortality and has good long term prognosis.

CONCLUSIONS: Ruptured SVA is a surgical emergency and rarely presents with hemopericardium. Immediate surgical intervention can be lifesaving and is the only recommended treatment in such cases. Thereby, all clinicians should be aware of this rare entity and its potential ways of presentations.

Reference #1: Ott D. Aneurysm of the sinus of Valsalva. Cardiac Surg Ann 2006; 9: 165-176

Reference #2: Vural KM, Sener E, Tasdemir O, Bayazit K. Approach to sinus of Valsalva aneurysms: a review of 53 cases. Eur J Cardio Thorac Surg 2001; 20:71-76

DISCLOSURE: The following authors have nothing to disclose: Khalid Sherani, Hineshkumar Upadhyay, Abhay Vakil, Kelly Cervellione, Sudheer Chauhan, Mohammad Babury

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