CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
e4
AFRICA
Case Report
Closure of ruptured aneurysm of the sinus of Valsalva
using a native aortic valve leaflet
Piotr Buczkowski, Maciej Walczak, Sebastian Stefaniak, Mateusz Pu
ś
lecki, Izabela Katy
ń
ska,
Marek Jemielity
Abstract
We present a case of the native valve used to complete closure
of a ruptured aneurysm of the sinus of Valsalva. Aneurysm
of the sinus of Valsalva is rare and a non-coronary artery
is affected in only 20% of cases. To close the rupture, we
decided to use a non-coronary leaflet in a young patient with
moderate aortic stenosis and fibrosis of the leaflets. In our
opinion, use of a native non-coronary valve leaflet should be
considered when making intra-operative decisions for repair
of non-coronary aneurysm of the sinus of Valsalva.
Keywords:
sinus of Valsalva, aortic valve replacement, ruptured
aneurysm
Submitted 10/2/14, accepted 22/4/14
Cardiovasc J Afr
2014;
25
: e4–e6
DOI: 10.5830/CVJA-2014-020
Aneurysm of the sinus of Valsalva is rare, the majority occurring
in males. It occurs when a congenital heart disease is combined
with the absence of normal elastic tissue and media in this
region. Nearly 70% of aneurysms of the sinus of Valsalva are
located in the right coronary sinus, 20% are non-coronary, and
the rest are in the left coronary artery.
1,2
Aneurysm of the sinus of Valsalva as a congenital disease is
very rare and is diagnosed in the third and fourth decades of life,
usually after rupture. Patients qualify for urgent cardiac surgery.
Depending on the location and penetration to other cavities of
the heart, we see a wide range of symptoms and haemodynamic
changes. There is no consensus on whether to operate or not for
non-ruptured aneurysms of the sinus of Valsalva.
3
Case report
A 50-year-old male with no past medical history was admitted
to our hospital for acute chest pain after salt water aspiration
while swimming. Initially he was hospitalised in the medical
observation unit because of jaundice. Blood tests showed
abnormalities, as presented in Table 1.
Ultrasonography of the abdomen revealed a large amount
of free fluid in the abdominal cavity, with liver enlargement.
Chronic hepatitis was diagnosed as liver failure. Pharmacological
treatment was administered and a cardiologist was involved in
the treatment.
Transthoracic echocardiography (TTE) revealed a ruptured
aneurysm of the non-coronary sinus of Valsalva with penetration
to the right atrium. Qp:Qs was 2.1:1. The patient was transported
to the cardiology clinic, where treatment was continued for the
next four days. After rapid deterioration, his clinical state
was unstable and he had right ventricular dysfunction with
cardiogenic shock (systolic blood pressure: 70 mmHg) and a
EuroSCORE II of 53.41%, the patient was moved to the cardiac
surgery unit for an emergency operation.
Using cardiopulmonary bypass (CPB) with superior and
anterior vein cannulation, the procedure was performed at 32°C
hypothermia, with cardiac protection in the form of cold 4°C
cardioplegic solution (St Thomas Hospital). After aortotomy,
the non-coronary aneurysm rupture of the sinus of Valsalva was
revealed, with a typical narrow band leading to the right atrium
(Fig. 1A, B).
The band from the right atrium was closed using Prolen
5-0. Because of the pre-operative diagnosis of moderate aortic
stenosis [peak-to-peak gradient (PPG
max
): 35 mmHg, aortic valve
area: 1.5 cm
2
], calcification and fibrosis of the right and left
coronary leaflets, and the relatively young age of the patient, a
decision was made to implant a mechanical prosthesis.
Department of Cardiac Surgery and Transplantology,
University of Medical Sciences Poznan, Poland
Piotr Buczkowski, PhD
Maciej Walczak, MD
Sebastian Stefaniak, MD,
Mateusz Pu
ś
lecki, PhD
Izabela Katy
ń
ska, MD
Marek Jemielity, MD
Table 1. Blood examination showing abnormal parameters.
Parameter
Mean value
Normal values
Bilirubin (mg/dl)
5.16
<
1.1
ALT (U/l)
2 706
5–40
AST (U/l)
1 940
5–40
Alkaline phosphatase (U/l)
86.1
20–70
GGT (U/l)
125.4
15–90
INR
2.15
0.8–1.2
ALT
=
alanine transaminase, AST
=
aspartate transaminase, GGT
=
gamma-glutamyl transferase.
