Circulation. 2006;114:e542-e543
doi: 10.1161/CIRCULATIONAHA.106.628073
(Circulation. 2006;114:e542-e543.)
© 2006 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Bilateral Sinus of Valsalva Aneurysms
An Extreme Case
Paraskevi A. Vlachou, MRCS;
Ian Loke, MRCP;
Derek Chin, FRCP;
Christina Vlachou, MBChB;
Christos Alexiou, PhD, FRCS;
Andrzej W. Sosnowski, FRCS;
Iain B. Squire, FRCP;
Richard Keal, FRCR
From the Departments of Radiology (P.A.V., R.K.), Cardiology (I.L., D.C., C.V., I.B.S.), and Cardiac Surgery (C.A., A.W.S.), University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Correspondence to Dr Paraskevi A. Vlachou, Department of Radiology, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. E-mail pvlachou{at}hotmail.com
A 55-year-old man with no significant cardiovascular risk factors presented with intermittent chest tightness on exertion as well as syncopal attacks of 3 months’ duration. Physical examination was unremarkable, and laboratory findings including troponin I levels were normal. The ECG did not show any ischemic changes apart from poor anterior R-wave progression. A chest radiograph showed mild cardiomegaly. An echocardiogram was performed that showed two large sinus of Valsalva aneurysms (Figure 1 and Movie I). These were confirmed by a contrast-enhanced, 16–multidetector-row computed tomography angiogram (Somatom 16, Siemens Medical Solutions, Erlangen, Germany) with retrospective ECG gating. Two giant sinus of Valsalva aneurysms of 7 cm maximum diameter were seen arising from the right and noncoronary sinuses. The aneurysms were compressing the right ventricle, right atrium, and left atrium. The ascending aorta was normal (Figure 2A through 2C and Movie II). The patient underwent surgical reconstruction of the aortic root to preserve the native aortic valve. However, perioperative bleeding around the Valsalva graft into the sinuses necessitated a formal aortic root replacement with a Shelhigh prosthesis as well as a right coronary bypass graft. A postoperative contrast-enhanced, ECG-gated computed tomography angiogram showed good appearance and size of the lumen of the ascending aorta graft and of the native left and grafted right coronary arteries. The dilated sinuses of Valsalva were thrombosed (Figure 3). The patient was discharged home 1 month later.
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Figure 1. Transthoracic echocardiogram of an apical 4-chamber view showing cystic masses (aneurysms) arising from the aortic root. An indicates aneurysms; LV, left ventricle; RV, right ventricle; and LA, left atrium.
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Figure 2. A and B, Multislice computed tomography of the chest after intravenous contrast medium administration, arterial phase, axial section. The right and noncoronary sinus of Valsalva aneurysms (An) are seen filling with contrast. LV indicates left ventricle. C, Sagittal reformatted CT image. Ao indicates aorta.
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Figure 3. Follow-up contrast-enhanced multislice computed tomography. Note the thrombosed appearance to the dilated sinuses of Valsalva (*).
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Acknowledgments
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Disclosures
None.
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Footnotes
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The online-only Data Supplement, which contains 2 movies, is available at http://circ.ahajournals.org/cgi/content/full/114/16/e542/DC1.
