Korean Circ J.  2014 Jul;44(4):274-277. 10.4070/kcj.2014.44.4.274.

A Case of Unruptured Aneurysm of the Right Sinus of Valsalva with Right Ventricular Outflow Obstruction

• Chung E
• Baek JY
• Chung HH
• Park SI
• Jang JH
• Yu HA
• Woo GH
• Youn HJ

• KMID: 2223891
• DOI: http://doi.org/10.4070/kcj.2014.44.4.274

Abstract

A 66-year-old man presented with exertional dyspnea. He was found to have an unruptured aneurysm of the right sinus of Valsalva causing significant right ventricular outflow obstruction. This aneurysm was diagnosed by transthoracic two-dimensional echocardiography, transthoracic three-dimensional echocardiography, transesophageal echocardiography, contrast echocardiography and 64-slice multidetector cardiac computed tomography. Because unruptured aneurysms of the sinus of Valsalva are rarely symptomatic, they can be difficult to detect. However, the unruptured aneurysm of the right sinus of Valsalva in this case caused significant right ventricular outflow tract obstruction, resulting in exertional dyspnea.

Keyword

Sinus of Valsalva; Aneurysm; Ventricular outflow obstruction

MeSH Terms

Aged
Aneurysm*
Dyspnea
Echocardiography
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Humans
Sinus of Valsalva*
Ventricular Outflow Obstruction*

Figure

• 

  Fig. 1 Transthoracic two-dimensional and three-dimensional echocardiography revealed a 1.35×3.0 cm unruptured aneurysm of the right sinus of Valsalva protruding into the RVOT. A: parasternal- and subcostal-view transthoracic echocardiography demonstrates an unruptured aneurysm of the right sinus of Valsalva. B: subcostal-view real-time three-dimensional echocardiography. An: body of the aneurysm, AoV: aortic valve, PA: main pulmonary artery, RA: right atrium, RV: right ventricle, RVOT: right ventricular outflow tract, LV: left ventricle, Ao: aorta.

• 

  Fig. 2 High flow acceleration around the aneurysm demonstrated that right ventricular outflow tract had been obstructed by it. A: color Doppler echocardiography demonstrates the turbulent flow associated with right ventricular outflow obstruction by an unruptured aneurysm of the sinus of Valsalva. B: continuous wave Doppler demonstrates the pressure gradient at the level of the aneurysm, suggesting right ventricular outflow obstruction. An: body of the aneurysm, RV: right ventricle.

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  Fig. 3 The substernal view after administration of intravenous echo contrast demonstrates the significant border between the body of the aneurysm and the right ventricle. An: body of the aneurysm, AoV: aortic valve, PA: main pulmonary artery, RA: right atrium, RV: right ventricle, RVOT: right ventricular outflow tract.

• 

  Fig. 4 64-slice multidetected computed tomography (MDCT) made it easy to determine the shape of the aneurysm and neighboring structures around it. A: 64-slice MDCT demonstrates an eccentric, lobulated aneurysm protruding into the right ventricular outflow tract. An arrow indicates the body of the aneurysm. B: a three-dimensional reconstruction demonstrates an unruptured aneurysm of the sinus of Valsalva. Arrows indicates the body of aneurysm. AoV: aortic valve, PA: main pulmonary artery, RV: right ventricle.

Reference

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