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A sinus of Valsalva aneurysm is a rare cardiac anomaly characterized by an abnormal dilatation of the aortic root. This occurs due to a weakened elastic lamina at the junction of the aortic media and the annulus fibrosus. The aneurysm can be congenital or acquired and comprises up to 3.5% of all congenital cardiac defects. Due to the aneurysm’s physiologic function and location, it can present significant clinical consequences in both the rupture and unruptured state. We present the case of a middle-aged male with no significant medical history who was found to have a massive unruptured sinus of Valsalva aneurysm. He was treated surgically with no postoperative complications.
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A sinus of Valsalva aneurysm is a rare cardiac anomaly characterized by an abnormal dilatation of the aortic root. This occurs due to a weakened elastic lamina at the junction of the aortic media and the annulus fibrosus. The aneurysm can be congenital or acquired and comprises up to 3.5% of all congenital cardiac defects. Due to the aneurysm’s physiologic function and location, it can present significant clinical consequences in both the rupture and unruptured state. We present the case of a middle-aged male with no significant medical history who was found to have a massive unruptured sinus of Valsalva aneurysm. He was treated surgically with no postoperative complications.

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A 52-year-old male with no significant medical history presented to the emergency department with a two-week onset of dry cough, rhinorrhea, and worsening dyspnea on exertion. An electrocardiogram on admission revealed left ventricular hypertrophy with repolarization abnormalities. Due to concerns for new-onset heart failure, a complete two-dimensional transthoracic echocardiogram (TTE) was performed, which revealed a circular fine structure within the left atrium, suggestive of an aneurysm (<a ref-type="fig" href="#j_rjc-2024-0014_fig_001">Figure 1a</a>). To further investigate the findings on TTE, a transesophageal echocardiogram (TEE) was subsequently done, revealing a sinus of Valsalva aneurysm with an associated bicuspid aortic valve (<a ref-type="fig" href="#j_rjc-2024-0014_fig_001">Figure 1b</a>). The patient underwent surgical repair of the unruptured aneurysm using a patch cut from a Valsalva aortic prosthesis Gelweave ValsalvaTM graft (Terumo Vascutek). The postoperative course was uncomplicated, and the patient completely recovered after three months.
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<h2>Figure 1</h2>
<figCaption>(A) Apical four chamber view transthoracic echocardiography showing a circular fine structure within the left atrium (arrow). LV, left ventricle; RV, right ventricle; RA, right atrium. (B) Mid-esophageal short axis TEE showing bicuspid aortic valve (orange arrows) and the sinus of Valsalva aneurysm (blue arrow).</figCaption>
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Sinus of Valsalva aneurysm, or SOVA, is a cardiac defect that is congenital or acquired with an estimated incidence of approximately 0.09 % in the general population.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_001">1</a> It is commonly associated with other congenital heart anomalies such as ventricular septal defects, bicuspid aortic valve, and pulmonary stenosis.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_001">1</a>,<a ref-type="bibr" href="#j_rjc-2024-0014_ref_002">2</a> They originate from the right coronary sinus in 70 to 90 percent of cases, followed by the noncoronary sinus (10%-25%) and the left sinus (&lt;5%).<a ref-type="bibr" href="#j_rjc-2024-0014_ref_003">3</a> Clinical presentation may be asymptomatic or may include acute rupture that clinically manifests with chest pain, dyspnea, palpitations, and cardiac murmurs.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_001">1</a>-<a ref-type="bibr" href="#j_rjc-2024-0014_ref_003">3</a> Cardiac computed tomography or magnetic resonance imaging may be used to aid in the diagnosis.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_003">3</a> However, TEE is preferred for anatomical delineation of aneurysmal origination, which will appear on two-dimensional imaging as a thin-walled mobile structure that is circular in the short axis.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_002">2</a>,<a ref-type="bibr" href="#j_rjc-2024-0014_ref_003">3</a> Surgical repair remains the preferred method of treatment.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_003">3</a>,<a ref-type="bibr" href="#j_rjc-2024-0014_ref_004">4</a> In patients with a ruptured SOVA, transcatheter closure devices are an acceptable alternative in those with suitable anatomy and high risk for cardiac surgery.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_002">2</a>,<a ref-type="bibr" href="#j_rjc-2024-0014_ref_005">5</a>
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Massive sinus of Valsalva aneurysm with an associated bicuspid aortic valve: A rare clinical image

Romanian Journal of Cardiology

This work is licensed under the Creative Commons Attribution 4.0 International License.

A sinus of Valsalva aneurysm is a rare cardiac anomaly characterized by an abnormal dilatation of the aortic root. This occurs due to a weakened elastic lamina...

Massive sinus of Valsalva aneurysm with an associated bicuspid aortic valve: A rare clinical image

Article Category: Image in Cardiology

Published Online: Jun 22, 2024

Page range: -

DOI: https://doi.org/10.2478/rjc-2024-0014

Keywords
Sinus of Valsalva aneurysm, Echocardiography, Bicuspid aortic valve, Cardiac magnetic resonance imaging, Cardiac computed tomography

© 2024 Kevan English, published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Massive sinus of Valsalva aneurysm with an associated bicuspid aortic valve: A rare clinical image

Article Category: Image in Cardiology

Published Online: Jun 22, 2024

Page range: -

DOI: https://doi.org/10.2478/rjc-2024-0014

KeywordsSinus of Valsalva aneurysm, Echocardiography, Bicuspid aortic valve, Cardiac magnetic resonance imaging, Cardiac computed tomography

© 2024 Kevan English, published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
Sinus of Valsalva aneurysm, Echocardiography, Bicuspid aortic valve, Cardiac magnetic resonance imaging, Cardiac computed tomography