From the Departments of Internal Medicine and Surgery (S.-H.C.), College
of Medicine, National Taiwan University Hospital.
A 59-year-old woman presented with exertional
dyspnea this past year. She gave no history of cardiac disease or
trauma. On examination, a soft systolic ejection murmur was
noted at the left sternal border. Her blood pressure was 110/74
mm Hg, and her pulse rate was 84 bpm. The ECG showed a normal sinus
rhythm with T-wave inversion in leads II, III, and aVF. Roentgenography
of the heart revealed mild cardiomegaly. Two-dimensional
transthoracic echocardiography
demonstrated a huge cystic mass (9.4x8.3 cm) with a ball-like thrombus
next to the aortic root extending into the right
ventricular outflow tract (Fig 1
Footnotes
Reprint requests to Dr Chiau-Suong Liau, Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan S Rd, Taipei, 10002, Taiwan.
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 McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine
Sinus of Valsalva Pseudoaneurysm
). Doppler color flow mapping showed
a turbulent flow in this cystic mass (Figs 2 and 3).
Rupture of the sinus of Valsalva with pseudoaneurysm formation
was diagnosed. During right heart catheterization, the
mean right atrial pressure was 11 mm Hg, the right
ventricular pressure was 24/5 mm Hg, the main
pulmonary artery pressure was 15/6 mm Hg, and the right
pulmonary artery wedge pressure was 7 mm Hg. During left
heart catheterization, her aortic pressure dropped from
110/70 to 55/35 mm Hg, and the patient became drowsy. For fear of
sudden rupture of the aortic pseudoaneurysm, the patient was
immediately transferred to the operating room for open-heart surgery.
During surgery, a huge, pulsating mass was noted over the right
ventricular free wall extending into the aortic root and
causing compression of the right ventricular outflow tract.
It was an aneurysm originating from the right coronary
sinus, and the aneurysm ruptured into the right
ventricular free wall between the epicardium and
myocardium. A 5x4x4-cm thrombus was noted within the
aneurysm. No ventricular septal defect was found.
The aneurysm was resected, and the rupture site was repaired
with a pericardial patch. Microscopic examination of the resected
tissue showed an atherosclerotic aorta with a false aneurysm
formation in the adventitial area. After the operation, the patient did
well.
View larger version (108K):
[in a new window]
Figure 1. A huge cystic mass with a ball thrombus
(arrowheads) in the parasternal long-axis view. Wall motion of this
mass was parallel to interventricular septal motion. AO
indicates aortic root; LA, left atrium; and LV, left ventricle.
View larger version (116K):
[in a new window]
Figure 2. Color flow mapping shows mosaic images at
junction of aortic root and neck of pseudoaneurysm.
View larger version (83K):
[in a new window]
Figure 3. Doppler flow shows systolic flow
toward aortic root during systolic phase.
This article has been cited by other articles:
 |
|
 |
|
  T. Fleck, M. Grabenwoger, D. Hutschala, and E. Wolner A rare cause of AV block III: aneurysm of the right ventricular inflow tract due to an orifice in the right coronary sinus of valsalva Eur. J. Cardiothorac. Surg., September 1, 2003; 24(3): 455 - 457. [Abstract] [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||