Korean Circ J.  2013 Nov;43(11):770-773. 10.4070/kcj.2013.43.11.770.

A Case of Right Sinus of Valsalva Rupture with Dissection into Interventricular Septum Causing Left Ventricular Outflow Tract Obstruction

• Lee DH
• Kang EJ
• Park TH
• Woo JS
• Hong SH
• Kim YD

• KMID: 2224810
• DOI: http://doi.org/10.4070/kcj.2013.43.11.770

Abstract

Sinus of Valsalva aneurysm (SVA) is an uncommon anomaly of the aorta. Rupture of SVA often precipitates dramatic clinical complications, including heart failures. Right SVAs are the most common type, and when they rupture, they usually rupture into the right ventricle or right atrium. Rupture into left ventricle or interventricular septum is rare. Herein, we report a case of right SVA rupture with dissection into interventricular septum, which produced significant left ventricular outflow tract obstruction and aortic regurgitation. The case was successfully treated by surgical operation.

Keyword

Sinus of Valsalva; Aneurysm; Ventricular outflow obstruction; Aortic valve insufficiency

MeSH Terms

Aneurysm
Aorta
Aortic Valve Insufficiency
Heart
Heart Atria
Heart Ventricles
Rupture*
Sinus of Valsalva*
Ventricular Outflow Obstruction

Figure

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  Fig. 1 Echocardiographic findings of SVA with interventricular dissection. Parasternal long axis view in TTE showing various sizes and appearances; increased size during diastole (A), decreased size during systole (B). Short axis view in TEE shows inflow from aortic root to SVA during diastole (C) and outflow during systole (D). SVA: sinus of Valsalva aneurysm, TTE: transthoracic echocardiography, TEE: transesophageal echocardiography.

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  Fig. 2 Transthoracic echocardiography with continuous wave Doppler study revealed significant left ventricular outflow tract obstructions with pressure gradients of 55 mm Hg.

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  Fig. 3 MDCT findings. A: left lateral view of reconstructed image well visualizes the right SVA. B: MDCT shows interventricular dissection which forms cystic cavity at diastole. C: the interventricular cavity increases in size during diastole. MDCT: multi-detector computed tomography, SVA: sinus of Valsalva aneurysm.

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  Fig. 4 Excised valvular tissues show dissected stroma by marked myxoid degeneration (A, H-E stain, ×40) and fibrillar degeneration with focal cystic changes in the central area of stroma (B, H-E stain, ×100).

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