J Cardiovasc Ultrasound.  2013 Mar;21(1):23-25. 10.4250/jcu.2013.21.1.23.

Ruptured Right Sinus of Valsalva Aneurysm to the Right Atrium Mimicking Acute Myocardial Infarction

• Lee JH
• Ryu SK
• Lee JH
• Park JY
• Choi JW
• Park MS
• Lim OK

• KMID: 1428373
• DOI: http://doi.org/10.4250/jcu.2013.21.1.23

Abstract

We present a rare case involving a ruptured sinus of Valsalva aneurysm (SVA) and acute myocardial infarction in a 39-year-old male patient. Coronary angiography showed normal findings; however, the patient showed remarkably elevated levels of cardiac enzymes and decreased left ventricular function with apical akinesia on transthoracic echocardiography. Transesophageal echocardiography revealed shunt flow from the SVA to the right atrium without significant aortic regurgitation. Preoperative cardiac arrest was managed by cardiopulmonary resuscitation, and surgical repair was performed by closing the entrance of the aneurysm. However, the compromised hemodynamic status was not reversed by surgery.

Keyword

Sinus of Valsalva; Myocardial infarction; Multiple organ failure

MeSH Terms

Aneurysm
Aortic Valve Insufficiency
Cardiopulmonary Resuscitation
Coronary Angiography
Echocardiography
Echocardiography, Transesophageal
Heart Arrest
Heart Atria
Hemodynamics
Humans
Male
Multiple Organ Failure
Myocardial Infarction
Sinus of Valsalva
Ventricular Function, Left

Figure

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  Fig. 1 An electrocardiogram obtained on admission showing sinus tachycardia and subtle ST depression in V5-6.

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  Fig. 2 Preoperative transesophageal echocardiography showing left-to-right shunt flow from the aortic sinus to the right atrium (arrow).

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  Fig. 3 Intraoperative findings show a sinus of Valsalva aneurysm originating from the right coronary cusp (A) and ruptured to the right atrium (B). LCC: left coronary cusp, RCC: right coronary cusp, RA: right atrium, NCC: non coronary cusp.

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