Ruptured Left Coronary Sinus of Valsalva Aneurysm Into the Left Ventricle

Article (PDF Available)inThe Annals of thoracic surgery 78(6):2187 · January 2005with13 Reads
DOI: 10.1016/S0003-4975(03)01417-6 · Source: PubMed
2004;78:2187 Ann Thorac Surg
Tomohiko Ukai and Akira Mishima
Takayuki Saito, Miki Asano, Michiko Ishida, Shigeru Sasaki, Norikazu Nomura,
Ruptured Left Coronary Sinus of Valsalva Aneurysm Into the Left Ventricle
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Ruptured Left Coronary Sinus of Valsalva
Aneurysm Into the Left Ventricle
Takayuki Saito, MD, Miki Asano, MD, Michiko Ishida, MD, Shigeru Sasaki, MD,
Norikazu Nomura,
MD, Tomohiko Ukai, MD, and Akira Mishima, MD
Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
R
uptured aneurysm originating from the left coronary
sinus toward the left ventricle (LV) is an extremely
rare problem and the incidence was reported as 1.8% of
all ruptured sinus Valsalva aneurysms [1]. This can cause
severe aortic regurgitation, coronary insufficiency, and
paroxysmal ventricular fibrillation [2].
A 59-year-old Japanese male presented with exertional
dyspnea. Chest roentogenogram revealed bilateral pleu-
ral effusion and cardiomegaly. Two hours after his ad-
mission he required resuscitation because of sudden
cardiopulmonary arrest. A two-dimensional echocardio-
gram demonstrated severe aortic regurgitation with com-
pensated LV contractility. Initially he was treated with
intensive medical care for congestive heart failure. De-
finitive diagnosis was confirmed on left-sided catheter-
ization. The aortogram showed the “wind-sock” appear-
ance of the aneurismal sac arising from the left coronary
sinus extruding into the LV (arrow in Fig 1). The left
coronary artery was intact (arrowhead in Fig 1) and no
associated lesion, such as ventricular septal defect, was
identified.
Standard cardiopulmonary bypass was used during
repair. The aneurysm was exposed through an oblique
aortotomy. The aortic valvular ring at the left coronary
sinus had detached completely from the aortic wall. The
sac tightly adhered to the free wall of the LV and the
bottom of the sac had perforated (asterisk in Fig 2). The
left coronary cusp, valvular ring (arrowheads in Fig 2), and
free wall of the aneurysmal sac were removed together.
In order to obtain firm anchorage of a mechanical valve,
mattress sutures with Teflon pledgets at the defect of
valvular ring were directly placed on the aortoventricular
junction where aneurismal wall adhering to the endocar-
dium had turned into scar tissue. Histologic examination
showed an accumulation of inflammatory cells (not only
mononuclear cells but also neutrophiles) implying that a
possible cause of aneurysmal formation was an infective
endocarditis although any organisms could be identified
from these specimens.
References
1. Au WK, Chiu SW, Mok CK, Lee WT, Cheung D, He GW.
Repair of ruptured sinus of valsalva aneurysm: determinants
of long-term survival. Ann Thorac Surg 1998;66:1604–10.
2. Glock Y, Ferrarini JM, Puel J, Fauvel JM, Bounhourne JP, Puel
P. Isolated aneurysm of the left sinus of Valsalva. Rupture
into the left atrium, left ventricle and dynamic coronary
constriction. J Cardiovasc Surg (Torino) 1990;31:235–8.
Address reprint requests to Dr Mishima, Department of Cardiovascular
Surgery, Nagoya City University Graduate School of Medical Sciences, 1
Kawasumi, Mizuho, Nagoya 467-8601, Japan; e-mail: mishima@med.
nagoya-cu.ac.jp.
Fig 1.
Fig 2.
© 2004 by The Society of Thoracic Surgeons Ann Thorac Surg 2004;78:2187 0003-4975/04/$30.00
Published by Elsevier Inc doi:10.1016/S0003-4975(03)01417-6
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2004;78:2187 Ann Thorac Surg
Tomohiko Ukai and Akira Mishima
Takayuki Saito, Miki Asano, Michiko Ishida, Shigeru Sasaki, Norikazu Nomura,
Ruptured Left Coronary Sinus of Valsalva Aneurysm Into the Left Ventricle
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    • "In our group, the incidence of SVA origin was 82.10% in the right coronary sinus, 17.51% in the non-coronary sinus, and 0.39% in left coronary sinus (Table 1). Rupture of SVA most often occurs into the right ventricle, followed by the right atrium [14,15], and rarely into the left ventricle [16,17], pulmonary artery [18], or interventricular septum. In our group, rupture into the right ventricle was 54.47%, into the right atrium 31.91%, and unrupture 13.62% (Table 1). "
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