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Giant unruptured Sinus of Valsalva aneurysm: an unusual cause of aortic regurgitation
  1. Malgorzata Lutaaya,
  2. Rajinikanth Rajagopal,
  3. Ranjit S More
  1. Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Blackpool, UK
  1. Correspondence to Dr Malgorzata Lutaaya, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Whinney Heys Road, Blackpool FY38NR, UK; dr.lutaaya{at}bfwhospitals.nhs.uk

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Sinus of Valsalva aneurysm (SVA) is rare (0.15%–1.5% of cardiopulmonary bypass cases) and usually presents acutely following rupture. Unruptured SVA is usually asymptomatic, but can lead to symptoms secondary to compression of adjacent cardiac structures. Ruptured SVA can lead to aortocardiac shunts and heart failure. About 65%–85% of SVAs originate from the right sinus, 10%–30% from non-coronary sinus and less than 5% from left sinus. SVA is often congenital. Causes of acquired SVA include atherosclerosis, infection and trauma. SVA is associated with increased morbidity and mortality and should be corrected by surgery or percutaneous device closure.

A 79-year-old man was referred to the cardiology clinic with 6 months history of progressive breathlessness. On examination, he had an early diastolic murmur in the aortic area and signs of right heart failure. Transthoracic echo showed severe aortic regurgitation and a very large unruptured SVA, arising from the right coronary sinus and compressing the right heart (figure 1). On CT scan, the aneurysm measured 9.7 cm in diameter (figure 2). There was no evidence of dissection or rupture. Cardiac catheterisation identified concomitant coronary artery disease. The patient underwent successful surgery with pericardial patch repair of the aneurysm, aortic valve replacement with a bioprosthesis and bypass grafts.

Figure 1

Apical four-chamber view on transthoracic echo demonstrating a large sinus of Valsalva aneurysm compressing the right heart.

Figure 2

3D CT reconstruction of the aortic root demonstrating a large aneurysm originating from the right sinus of Valsalva.

The diagnosis of SVA is usually made incidentally on transthoracic echo. Newer imaging modalities like CT and MRI can define the anatomy of the aneurysm, adjacent structures and the aorta and guide surgical treatment.

Footnotes

  • Contributors ML made the original diagnosis, prepared the images and helped with the manuscript. RR reviewed the literature and prepared the manuscript. RSM reviewed the original images, made the diagnosis and reviewed the manuscript.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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