alexa Successfully Surgical Repair of Giant Unruptured Aneurysm of the Sinus of Valsalva | Open Access Journals
ISSN: 2165-7920
Journal of Clinical Case Reports
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Successfully Surgical Repair of Giant Unruptured Aneurysm of the Sinus of Valsalva

Kenan Abdurrahman Kara1*, Erhan Hafız2, Murat Arı3, Müslüm Polat3, Eyüp Murat Kanber3 and Gökalp Güzel3

1Department of Cardiovascular Surgery, Hisar Intercontinental Hospital, Ümraniye, Istanbul, Turkey

2Department of Cardiovascular Surgery, Gaziantep University Hospital, Sahinbey, Gaziantep, Turkey

3Department of Cardiovascular Surgery, Gaziantep ersin Arslan Research and Training Hospital, Sahinbey, Ga-ziantep, Turkey

*Corresponding Author:
Kenan Abdurrahman Kara
Department of Cardiovascular Surgery
Hisar Intercontinental Hospital
Ümraniye, Istanbul, Turkey
Tel: +90530 0655225
Fax: +90 216 5241323
E-mail: [email protected]

Received Date: April 20, 2017; Accepted Date: June 22, 2017; Published Date: June 27, 2017

Citation: Kara KA, Hafiz E, Ari M, Polat M, Kanber EM, et al. (2017) Successfully Surgical Repair of Giant Unruptured Aneurysm of the Sinus of Valsalva. J Clin Case Rep 7:985. doi: 10.4172/2165-7920.1000985

Copyright: © 2017 Kara KA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Clinical Case Reports

Abstract

Aneurysmal dilatation and progressive enlargement of one of the sinuses of Valsalva, most often occurs on the site of right coronary sinus and normally goes undetected during life until its rupture. Rarely, the aneurysm presents with evidence of obstruction of the right ventricular outflow tract, aortic insufficiency, conduction abnormalities, or coronary artery compression in the absence of rupture. The biggest size in the literature of aneurysm was reported as 8 cm. In this case report, we present successful surgical repair of 10 cm large sinus of Valsalva aneurysm with Bentall procedure.

Keywords

Aneurysmal dilatation; Sinuses; Aortic; Dyspnea

Introduction

Since its first description in 1840 by Thurman, varying terminologies and classifications have been used. In 1962, Sakakibara and Konno [1] documented four types of aneurysm but did not account for a description of the penetration of ruptured aneurysms. The classic congenital sinus of Valsalva aneurysm is defined as the dilation or enlargement of one of the aortic sinuses between the aortic valve annulus and the Sino tubular ridge. Multiple sinus dilation should be considered as a separate entity, namely, as aneurysmal dilation of the aortic root. By definition, the true sinus of Valsalva aneurysm arises from above the aortic annulus, in contrast to the prolapsing aortic cusp below the annulus. The sinus of Valsalva aneurysm, like many other congenital cardiac lesions, has to be defined carefully before its devastating results occur.

There have been a few reported cases of unruptured sinus of Valsalva aneurysms [2] but not in this size of aneurysm (10 cm). We describe a patient with an unruptured 10 cm aneurysm of the sinus of Valsalva.

In our case a 50-year-old man presented with intermittent dizziness and electrocardiographic evidence of a severe conduction disturbance, echocardiographic LVEF with 25%. During surgical transesophagial echocardiography showed an enlarging aneurysm of the right sinus of Valsalva. Successful surgical repair was carried out with Bentall procedure.

Case Report

50-year-old Turkish man was admitted with a history of weakness, and mild dyspnea with a 2-year diagnosis history as an aneurysm of the ascending aorta. There was no history of recent chest pain or injury. On examination, his pulse was normal with a regular rhythm at a rate of 70 beats/min.

The transthoracic echocardiography was reported as aneurysm of aortic root and ascending aorta with global hypokinesia and hypertrophia of left ventricle (Figure 1). On Cardiac CT, a large aneurysm of the right coronary sinus of Valsalva was found. Aneurysm size was measured between 84.30 mm to 97.83 mm (Figure 2). During a surgical procedure, the ascending aorta was normal, aneurysm of sinus Valsalva was giant with size of 10 cm (Figure 3). After the axillar cannulation and sternotomy, bicaval cannulation was performed. Aortotomy was from top of the aneurysm on thinnest place, the right coronary cusp of the aortic valve was abnormaly left side distorted. The other two cusps and sinuses was slightly distorted. The aneurysm was bulging into the right ventricle and to a lesser extent into the left ventricular outflow tract (Figure 4).

clinical-case-reports-transthoracic-echocardiography

Figure 1: The transthoracic echocardiography was reported as aneurysm of aortic root and ascending aorta with global hypokinesia and hypertrophia of left ventricle.

clinical-case-reports-large-aneurysm

Figure 2: On Cardiac CT, a large aneurysm of the right coronary sinus of Valsalva was found. Aneurysm size was measured between 84.30 mm to 97.83 mm.

clinical-case-reports-surgical-procedure

Figure 3: During a surgical procedure, the ascending aorta was normal, aneurysm of sinus Valsalva was giant with size of 10 cm.

clinical-case-reports-lesser-extent

Figure 4: The aneurysm was bulging into the right ventricle and to a lesser extent into the left ventricular outflow tract.

The aneurysm was left opened and the aortic valve was replaced with a No:25 St. Jude Medical bileaflet mechanical valved graft with sinus Valsalva (Gelweave Valsalva Technology). Postoperatively, the patient had an uneventful recovery.

Discussion

Sinus of Valsalva aneurysms are usually remained asymptomatic and undetected, unless rupture occurs. As symptoms, patients may present acute right heart failure, exertional dyspnea, palpitations, and angina like chest pain [3]. In our patient, symptoms were presented as insufficiency of right ventricle. These aneurysms may be congenital, due to a deficiency in the muscular and elastic tissues at the base of the aorta, or acquired after infective endocarditis, atherosclerosis, or aortic dissection [4]. In our case etyology was genetic, because brother of our patient has died with similar history.

The surgical approach depends on some various factors, such as whether the aneurysm is ruptured, the necessity to repair or replace the aortic valve or aortic valve with aortic root (Bentall procedure). Like we have shown in our Figure 4, the aneurysm is contiguous to sternum. We think that surgical approach to the aneurysm needed to be very careful from beginning with sternotomy, because of deviation is mostly versus right coronary sinus, which was like in our patient. Especially in these cases with giant aneurysm of ascendant aorta, the choice of aortic cannulation must be from axillary or femoral artery.

In ascendant aortic surgery, the surgical choice of procedure in pathological sinotubular junction is known very well. Involvement in this predicted area sinus of Valsalva aneurysm is interesting.

Successful results of Valve sparing reimplantation technics has been reported if there was no any pathology on leaflets structure. Neo sinus Valsalva procedure with Dacron graft is rarely applied technic if only one sinus Valsalva affected especially in noncoronary sinus Valsalva affected cases. But in our case, we prefered modified Bentall de bono procedure with button technic, due to sinus Valsalva was pathologically dilated especially the right coronary sinus and also because of the impaired sinus Valsalva and fibrotic leaflets leads valve coaptation competence was impossible. We used bileaflet mechanical valved greft with sinus Valsalva because of it effects the flow dynamics in positive way and also increases the coronary diastolic reserve [5].

Conclusion

Cases of unruptured giant sinus of Valsalva aneurysm are extremely rare. Only this case has been reported in our department. As we know, any case in this size of aneurysm (10 cm) has not been reported yet. Our patient presented with symptoms of insufficiency of right ventricle. A good prognosis depends on early diagnosis and prompt surgical intervention. However, we think the best surgical procedure is modified Button Bental procedure, as we did in our case.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

  • Global Experts Meeting on Case Reports
    Osaka, Japan October 09-11, 2017
  • 6th Global Experts Meeting on Medical Case Reports
    October 16-18, 2017 San Francisco, California, USA

Article Usage

  • Total views: 306
  • [From(publication date):
    June-2017 - Sep 20, 2017]
  • Breakdown by view type
  • HTML page views : 280
  • PDF downloads :26
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

[email protected]

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

[email protected]

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords