Circulation. 1999;100:1843-1844
(Circulation. 1999;100:1843-1844.)
© 1999 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Sinus of Valsalva Aneurysm With Rupture Into the Interventricular Septum and Left Ventricular Cavity
T. Wells, MD;
B. Byrd, MD;
D. Neirste, MD;
C. Fleurelus, MD
From the Department of Cardiology, Vanderbilt University Medical Center,
Nashville, Tenn.
Correspondence to Tim Wells, MD, Department of Cardiology, 315 MRB II, Vanderbilt University Medical Center, Nashville, TN 37232-6300.
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Introduction
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 Top
 Introduction
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A23-year-old Haitian
man presented with complaints of shortness
of breath, dyspnea
on exertion, and occasional palpitations.
Examination revealed a wide
pulse pressure and a continuous
murmur across the precordium. The
echocardiogram showed a ruptured
aneurysm of the right sinus of
Valsalva (Figure 1
). The sinus
rupture
dissected into the interventricular septum and then
ruptured
into the left ventricular cavity (Figures 2
and 3
).
No operative
intervention was undertaken.
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Figure 1. A, Parasternal short-axis view of aortic valve
(Aov) shows aneurysmal cavity (An) arising from right sinus of
Valsalva. B, In same view, color Doppler shows flow from ruptured
right sinus of Valsalva into aneurysmal cavity. RV indicates
right ventricle; PA, pulmonary artery.
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Figure 2. Parasternal short-axis view of left ventricle (LV)
shows ruptured sinus of Valsalva aneurysm (A) dissecting into
interventricular septum.
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Figure 3. Apical 4-chamber view shows turbulent
diastolic color flow through sinus of Valsalva
aneurysm (A), which has dissected into
interventricular septum and then back into left
ventricle.
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Aneurysms of the sinus of Valsalva account for only 1%
of congenital cardiac anomalies. Of these aneurysms, 70% arise
from the right sinus of Valsalva. Most of the remainder arise from the
noncoronary sinus, and <5% from the left coronary
sinus. Complications of sinus of Valsalva aneurysms include
aortic insufficiency, coronary artery flow compromise,
arrhythmia, and rupture. Most commonly, rupture occurs from the
right coronary sinus into the right ventricle or right atrium.
However, rupture may also occur into the pericardium, the pleural
space, or the left heart chambers. Dissection of a ruptured sinus of
Valsalva aneurysm into the interventricular septum
has been reported only rarely. This is the only case in which 2D and
color Doppler imaging demonstrate rupture of the right
coronary sinus, with dissection into the
interventricular septum, and rupture into the left
ventricular cavity.
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Footnotes
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister,
Jr, MD, Chief, Department of Pathology, St Luke's Episcopal
Hospital and Texas Heart Institute, and Clinical Professor of
Pathology, University of Texas Medical School and Baylor College
of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
