CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
e6
AFRICA
(RAoSV). Despite the fact that this congenital disease is
usually seen in the third to fourth decades of the life,
1
we found
pathology of the native valve in this 50-year-old patient, with an
indication for its replacement. We believe in this situation the use
of a native valve was acceptable.
The use of a native valve leaflet is reasonable when it needs
no alteration, and there is dysfunction of the valve needing
replacement. Use of a native leaflet can only be performed for
repair of an aneurysm of the non-coronary sinus of Valsalva.
This case shows how important a quick decision is for surgical
or transcatheter treatment. Four days of delay led to right
ventricular dysfunction with cardiogenic shock, and symptoms
of multi-organ failure, which were probably involved in the fatal
patient outcome.
Our patient was operated on as an emergency with a
diagnosis of moderate aortic valve stenosis. When the patient’s
clinical state is stable, other less-invasive techniques of RAoSV
treatment, such as transcatheter closure, should be involved.
The first report of transcatheter closure of a ruptured
aneurysm of the sinus of Valsalva with the use of Rashkind
umbrella was published in 1994 by Cullen.
4
Today we find
many interesting case presentations of RAoSV closure with a
new generation of devices; the Amplatzer septal occluders or
Amplatzer duct occluders.
5,6
Patients undergoing transcatheter device closure are
spared the morbidity related to a sternotomy and the use of
cardiopulmonary bypass. As it is an effective and safe treatment
modality for isolated RAoSV, it is usually reported in case
reports or short early and mid-term results in small groups of
usually less than 10 patients.
Transcatheter device closure can be lifesaving if it can be
done within a short space of time in heart-failure patients in
a poor general condition and with co-morbidities. In hospitals
with no teams experienced in transcatheter closure techniques,
or in haemodynamically unstable patients, cardiac surgery is still
the gold standard in treating patients with RAoSV.
7
In our case,
double re-operation due to fluid drainage, and with the INR
above 2.5 (after the use of Octaplex and fresh frozen plasma)
could have led to the final septic state.
Conclusion
In surgery on patients with ruptured aneurysm of the
non-coronary sinus of Valsalva and with aortic valve disease, the
use of native valve leaflets should be considered. Rupture of the
sinus of Valsalva with significant left-to-right shunt should be an
indication for urgent surgery or transcatheter closure.
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