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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 5  |  Issue : 3  |  Page : 125-126

Rupture of noncoronary sinus of Valsalva into right atrium in the fifth decade of life


1 Department of Cardiology, Sabah Al Ahmad Cardiac Center, Amiri Hospital, Kuwait City, Kuwait
2 Department of Cardiology, Meditrina Hospitals, Kottarakara, Kollam, Kerala, India

Date of Web Publication12-Sep-2017

Correspondence Address:
R Rajan
Department of Cardiology, Sabah Al Ahmad Cardiac Center, Amiri Hospital, Kuwait City
Kuwait
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/heartindia.heartindia_19_17

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  Abstract 

Ruptured noncoronary sinus of Valsalva is a rare condition which was first reported in 1974. The majority of RSOV drains into right-sided chambers and rarely to the left. RSOV is an anatomical defect due to failure of fusion between heart and aortic media with an aneurysmal enlargement which ruptures due to elevated pressures at the aortic root, infective endocarditis, trauma, etc. Here, we are reporting a 57-year-old male diagnosed to have RSOV incidentally. This case report highlights the need for immediate care and prescribing treatment strategies to avoid dreadful complications such as infective endocarditis.

Keywords: Echocardiography, noncoronary sinus, right atrium, rupture of sinus of Valsalva


How to cite this article:
Rajan R, Amin O, Soman B, Dashti R, Al Jarallah M. Rupture of noncoronary sinus of Valsalva into right atrium in the fifth decade of life. Heart India 2017;5:125-6

How to cite this URL:
Rajan R, Amin O, Soman B, Dashti R, Al Jarallah M. Rupture of noncoronary sinus of Valsalva into right atrium in the fifth decade of life. Heart India [serial online] 2017 [cited 2017 Dec 14];5:125-6. Available from: http://www.heartindia.net/text.asp?2017/5/3/125/214424


  Introduction Top


Ruptured noncoronary sinus of Valsalva without aneurysm is a rare anomaly, especially when it drains into the right atrium (RA).[1],[2] This can be congenital or acquired condition. Ruptured sinus of Valsalva (RSOV) may cause significant hemodynamic worsening, and it may result in heart failure and even death.[3] Echocardiography usually plays vital role in the process of diagnosis. Transesophageal echocardiography (TEE) and cardiac catheterization are gold standards for its diagnosis.


  Case Report Top


A 57-year-old Egyptian male with no medical history presented to our emergency room with palpitation and atypical chest pain of 1-week duration. Chest pain was on and off. On examination, he was hemodynamically stable, heart rate of 66/min, and blood pressure 100/70 mmHg. On auscultation, a 3/6 systolic murmur was heard at the right sternal border. Laboratory findings were within normal limits. The electrocardiogram showed atrial fibrillation with controlled ventricular rate. Two-dimensional transthoracic echocardiography findings showed good left ventricle systolic function with and an ejection fraction of 55% a small defect noted at the level of noncoronary cusp with normal left and right atria [Figure 1]. TEE revealed 3 mm small defect at the noncoronary cusp close to the junction with right coronary cusp with left to right shunt into RA just above the insertion of septal leaflet of the tricuspid valve [Figure 2].
Figure 1: Two-dimensional transthoracic echocardiography in the short-axis view at the level of great arteries showing a small defect at the level of noncoronary cusp with normal left and right atria

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Figure 2: Transesophageal Echocardiography revealed 3 mm small defect at the noncoronary cusp close to the junction with right coronary cusp with left to right shunt into right atrium just above the insertion of septal leaflet of the tricuspid valve

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Our patient was referred to cardiac surgery for the surgical closure of RSOV rupture and further management. Patient wanted to undergo surgery abroad. Hence, lost to follow-up.


  Discussion Top


Rupture of sinus of Valsalva is a rare occurrence; its prevalence is <1%.[2] Majority of the aortic sinus of Valsalva aneurysms are congenital, some are associated with syphilis, endocarditis, trauma, atherosclerosis, and aortic dissection.[4],[5],[6] They develop symptoms of heart failure after rupture which usually occurs by the fourth decade.[6],[7] Males are affected more (4:1) and the prevalence is higher among Asians when compared to other ethnic groups.[8]

The rupture of noncoronary cusp is fairly uncommon, accounting for nearly 20% of the cases, rupture of right coronary sinus of Valsalva is the most common (65%–75%) and left coronary cusp ruptures accounts for <5% of the cases.[6],[9],[10] Usually, noncoronary sinus aneurysm rupture communicates with the RA.[2],[3],[6]

Echocardiography (transthoracic or transesophageal) is the investigation of choice and surgery is the preferred treatment,[8],[11] though is selected favorable cases, percutaneous intervention with an amplatzer duct occluder has been successful.[8],[12]


  Conclusion Top


Diagnosis was confirmed by transthoracic and transesophageal echocardiography and was referred for surgical correction. Early detection and surgical management of the defect are vital. Echocardiography plays a vital role in the early diagnosis of such cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Islam MN, Alimuzzaman M, Khan MN, Bashar MA, Zafar A. Ruptured aneurysm of the sinus of Valsalva. Bangladesh Med Res Counc Bull 1996;22:19-26.  Back to cited text no. 1
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2.
Takach TJ, Reul GJ, Duncan JM, Cooley DA, Livesay JJ, Ott DA, et al. Sinus of Valsalva aneurysm or fistula: Management and outcome. Ann Thorac Surg 1999;68:1573-7.  Back to cited text no. 2
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3.
Dong C, Wu QY, Tang Y. Ruptured sinus of valsalva aneurysm: A Beijing experience. Ann Thorac Surg 2002;74:1621-4.  Back to cited text no. 3
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4.
Ikenaga S, Minami Y, Itoh H, Suzuki K, Hamano K. Acceleration of aortic regurgitation due to localized aortic dissection; report of a case. Kyobu Geka 2004;57:388-90.  Back to cited text no. 4
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5.
Zhao G, Seng J, Yan B, Wei H, Qiao C, Zhao S, et al. Diagnosis and surgical treatment of ruptured aneurysm in sinus of Valsalva. Chin Med J (Engl) 2003;116:1047-50.  Back to cited text no. 5
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6.
Mwambingu TL, Matthews IG, Thambyrajah J, Andrew Owens W. Interatrial rupture of a non-coronary sinus of Valsalva aneurysm: A rare presentation of a rare disorder. Interact Cardiovasc Thorac Surg 2011;13:664-5.  Back to cited text no. 6
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7.
Ring WS. Congenital Heart Surgery Nomenclature and Database Project: Aortic aneurysm, sinus of Valsalva aneurysm, and aortic dissection. Ann Thorac Surg 2000;69 4 Suppl: S147-63.  Back to cited text no. 7
    
8.
Cao LB, Hannon D, Movahed A. Noncoronary sinus of Valsalva rupture into the right atrium with a coexisting perimembranous ventricular septal defect. World J Clin Cases 2013;1:146-8.  Back to cited text no. 8
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9.
Fishbein MC, Obma R, Roberts WC. Unruptured sinus of Valsalva aneurysm. Am J Cardiol 1975;35:918-22.  Back to cited text no. 9
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10.
Meier JH, Seward JB, Miller FA Jr., Oh JK, Enriquez-Sarano M. Aneurysms in the left ventricular outflow tract: Clinical presentation, causes, and echocardiographic features. J Am Soc Echocardiogr 1998;11:729-45.  Back to cited text no. 10
    
11.
van Son JA, Danielson GK, Schaff HV, Orszulak TA, Edwards WD, Seward JB. Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm. Circulation 1994;90 (5 Pt 2):II20-9.  Back to cited text no. 11
    
12.
Kerkar PG, Lanjewar CP, Mishra N, Nyayadhish P, Mammen I. Transcatheter closure of ruptured sinus of Valsalva aneurysm using the Amplatzer duct occluder: Immediate results and mid-term follow-up. Eur Heart J 2010;31:2881-7.  Back to cited text no. 12
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    Figures

  [Figure 1], [Figure 2]



 

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