Korean Circ J.  2011 Aug;41(8):464-468. 10.4070/kcj.2011.41.8.464.

Aneurysm of Sinus of Valsalva Dissecting Into the Interventricular Septum After Aortic Valve Replacement: Diagnosis by Echocardiography and Magnetic Resonance Imaging and Treatment With Surgical Sealant

• Park KH
• Shin DG
• Son CW
• Son JW
• Jo HS
• Yoon JC
• Lee WJ
• Lee SH
• Hong GR
• Park JS
• Kim YJ
• Choi JH
• Lee DH

• KMID: 1826354
• DOI: http://doi.org/10.4070/kcj.2011.41.8.464

Abstract

Aneurysm of the sinus of Valsalva that causes dissection of the interventricular septum is an extremely rare entity. In this report we describe a case of aneurysm of the sinus of Valsalva dissecting into the interventricular septum, from the base to mid septum, after aortic valve replacement. After the diagnosis was made by transthoracic echocardiography and magnetic resonance imaging, the patient was successfully treated with surgical sealant-mediated occlusion of the aneurysmal sac and cardiac resynchronization therapy used for the first time.

Keyword

Ventricular septum; Heart aneurysm; Heart valve prosthesis implantation

MeSH Terms

Aneurysm
Aortic Valve
Cardiac Resynchronization Therapy
Echocardiography
Heart Aneurysm
Heart Valve Prosthesis Implantation
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Sinus of Valsalva
Ventricular Septum

Figure

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  Fig. 1 The electrocardiogram on admission showed complete LBBB with wide QRS interval of about 200 milliseconds. LBBB: left bundle branch block.

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  Fig. 2 Transthoracic echocardiography in the apical 4-chamber view on admission revealed a huge dissecting cystic mass-like aneurysm (5.0×3.5 cm) in the interventricular septum from the basal to mid-septal level filled with a focal thrombus (arrow). LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle.

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  Fig. 3 Transthoracic echocardiography in the apical 5-chamber view (A) and the parasternal short axis view (B) on admission showed diastolic flow communicating (white arrow) from aortic root to interventricular aneurysm on color Doppler echocardiography. *Aortic valve. LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle.

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  Fig. 4 MRI showed dissecting aneurysm of the interventricular septum from the basal to mid-septal level (A: sagittal view, B: transversal view). Peri-prosthetic leak into the interventricular septal aneurysm (arrow) is seen in both A and B. MRI: magnetic resonance imaging, LA: left atrium, LV: left ventricle, PA: pulmonary artery, RA: right atrium, RV: right ventricle.

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  Fig. 5 Intraoperative photography showed the aneurysmal opening (arrow) arising from the left sinus of Valsalva into the interventricular septum.

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  Fig. 6 Transthoracic echocardiography in the apical 4-chamber view after surgery showed a change in the dissecting aneurysm (arrow) with aneurysmal size decreasing from 5.0×3.5 cm to 3.2×1.8 cm, and most of the space being filled with a thrombus. LV: left ventricle, RV: right ventricle.

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