A Case Report Ruptured Sinus of Valsalva Aneurysm With Vegetation in Right Atrium


NM Zahangir,S T Ahmed*

Citation: A Case Report Ruptured Sinus of Valsalva Aneurysm With Vegetation in Right Atrium. American Research Journal of Cardiovascular Diseases, Volume 2016; pp:1-7

Copyright This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited


Abstract:

Background

Ruptured sinus of Valsalva aneurysm with moderate aortoic regurgitation with vegetation in right atrium is a rare disorder. Prompt diagnosis and surgical intervention gives good result.

Methods

33 years old gentleman came to our hospital with ruptured non-coronary sinus of valsalva into right atrium. Operation was done on 15.11.12. Non coronary sinus was hugely dilated with a perforation at apex . Double ended pledgeted horizontal mattress suture was applied to aneurismal area around the perforation in normal healthy tissue. Right atrium was opened , about 4cm long vegetation was found, it was excised .Double ended pledgeted horizontal mattress suture was applied around the perforation site in Right atrium. PTFE patch closure of aneurismal part of Non coronary sinus of aorta was done,sutures were passed through normal healthy sinus tissue. Now aortic cusp coaptation was checked by saline test –found good coaptation. Cross clamp was removed .Weaning from CPB was done uneventfully .TEE was done after weaning from CPB—no leakage was found through the patch are and no aortic regurgitation was present. 

Results

No growth was found in Culture Sensitivity test and histopathological examination revealed ruptured aneurysm of sinus of valsalva. Minimum ionotropes were needed in ICU. Postoperative echo on 5th postoperative day revealed—no leakage through patch area ,no AR,good LV and RV function. The patient was discharged from hospital on 6th postoperative day in good general condition and doing well till now. 

Conclusions

A sinus of Valsalva aneurysm rupture is a rare entity, vegetation is further rare association. Early surgery gives good result.


Description:

                                                                                              INTRODUCTION

Sinus of valsalva aneurysm occurs infrequently, with an incidence of 0.14% to 3.5% in patients undergoing open heart surgical procedures. Males are 3- to 4-times more often affected than females, and the incidence of ruptured sinus of valsalva aneurysm is higher in Asian (1.2%–4.94%) than in Western populations (0.5%–1.5%)1. Early diagnosis and treatment achieves good outcome.

                                                                                                   METHODS

33 years old gentleman came to our hospital from abroad with severe respiratory distress on mild exersion, palpitation and chest pain. Blood Pressure was 120/50 mm Hg, Physical examination revealed an engorged jugular vein and mild leg edema.A continuous heart murmur was heard over the right sternal border. Chest x-ray revealed-huge cardiomegally. Echocardiogram showed ruptured non-coronary sinus of valsalva into right atrium. Operation was done on 15.11.12. After heparinization CPB was established by aortic and bicaval venous cannulation. Heart was made to fibrillate by fibrilator and aortotomy was done. Heart was then arrested at diastole by cardioplegic solution delivered through coronary ostea. A large vegetation was attached with the edge of the ruptured sinus which was protruded into right atrium and right ventricle during diastole. After sternotomy right atrium was found hugely dilated. Non coronary sinus was hugely dilated with a perforation at apex . Double ended pledgeted horizontal mattress suture was applied to aneurysmal area around the perforation in normal healthy tissue. Right atrium was opened , about 4cm long vegetation was found, was attached to the connecting site of Non coronary aneurysmal sinus, it was excised and was sent for culture sensitivity test and histopathological examination. Double ended pledgeted horizontal mattress suture was applied around the perforation site in Right atrium. PTFE patch closure of aneurismal part of Non coronary sinus of aorta was done, sutures were passed through normal healthy sinus tissue. Now aortic cusp coaptation was checked by saline test –found good coaptation. Cross clamp was removed .Weaning from CPB was done uneventfully .TEE was done after weaning from CPB—no leakage was found through the patch area and no aortic regurgitation was present.

No growth was found in culture sensitivity test and histopathological examination revealed ruptured aneurysm of sinus of valsalva. Minimum ionotropes were needed in ICU. Postoperative echo on 5th postoperative day revealed—no leakage through patch area ,no aortic regurgitation was present with good LV and RV function. The patient was discharged from hospital on 6th postoperative day in good general condition.