Aortic Sinus of Valsalva Thrombosis Presenting as Limb Ischemia: A Case Report.
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ABSTRACT:
SUBMITTER: Shah DA
PROVIDER: S-EPMC8236379 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND AND OBJECTIVES:Leaflet thrombosis after transcatheter aortic valve replacement (TAVR) has been reported recently, whereas thrombus formation in sinus of Valsalva has yet to be fully evaluated. This study describes clinical and cardiac computed tomography (CT) findings of patients with sinus of Valsalva thrombosis. METHODS:Between March 2011 and Aug 2019, 192 patients underwent cardiac CT after TAVR. After a retrospective review of CT images, 9 patients (82 years, male:female=2:7) who had sinus of Valsalva thrombosis identified by cardiac CT were selected for this study. Patient demographics, interval between TAVR and cardiac CT scan, location and CT attenuation of sinus of Valsalva thrombosis, and presence of concurrent leaflet thrombosis were evaluated. RESULTS:The median interval between TAVR and cardiac CT was 11 days. Sinus of Valsalva thrombosis was frequently detected in the non-coronary sinus (89%, 8/9), and predominantly located in the bottom of the sinus extending upward towards the sinotubular junction. Three patients had concomitant leaflet thrombosis, and 3 patients had subclinical embolic stroke noted on brain magnetic resonance imaging. All patients had been prescribed aspirin and clopidogrel after TAVR for at least 6 months without anticoagulants. CONCLUSIONS:Cardiac CT after TAVR can detect sinus of Valsalva thrombosis, and attention should be paid to this potential source of subsequent systemic embolization.
| S-EPMC7321751 | biostudies-literature
Project description:Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that can be congenital or acquired. Unruptured aneurysms may be asymptomatic but can present as malignant arrhythmias, acute chest pain, and even sudden cardiac death. Both ruptured and unruptured SVAs may have fatal complications, thus prompt diagnosis and surgery is critical. We report a successful surgical repair of an unruptured aneurysm of the left sinus of Valsalva presenting as acute coronary syndrome. Coronary angiography (CAG) and cardiac multislice computed tomography (CT) revealed a large unruptured aneurysm of the left sinus of Valsalva. Surgical repair was performed by resection of the aneurysm, aortic valve replacement with composite graft, and coronary artery bypass. Aneurysm of the left sinus of Valsalva is an extremely rare condition. Correct diagnosis can be done by echocardiography, CAG, or CT. Non-ruptured aneurysms should be surgically repaired if they are associated with significant symptoms or if their size enlarge rapidly.
| S-EPMC6601242 | biostudies-literature
Project description: Not available
| S-EPMC8453373 | biostudies-literature
Project description:A separation between the aortic media and annulus fibrosus causes a rare cardiac abnormality called sinus of Valsalva aneurysm (SVA) that may be congenital or acquired. It is more prevalent in the right coronary sinus (65%-85%) but it has been seen rarely in non-coronary (10%-30%) or Left coronary sinus (<5%). The most common complication is rupture of the Aneurysm. We present an 80-year-old male with expanding right Valsalva sinus aneurysm and protruding into right ventricle. The conventional treatment is surgical repair under cardio-pulmonary bypass or percutaneous catheter closure. The aneurysm was successfully excised surgically under direct guidance of trans-esophageal echocardiography (TEE).
| S-EPMC4586600 | biostudies-literature
Project description: Not available
| S-EPMC7026551 | biostudies-literature
Project description:Background: Papillary fibroelastomas are rare benign heart tumors, and is most likely to involve the cardiac valves. We will present an extremely rare localization of a large Valsalva sinus fibroelastoma, with occasional left coronary artery ostial obstruction presented as an acute coronary syndrome. The tumor was removed surgically and histologically confirmed as papillary fibroelastoma. This review points to the crucial importance of multidisciplinary team decision and multimodality imaging methods for diagnosing the fibroelastoma, determination of size, and localization, which avoided complications of fatal embolization during an invasive procedure. Case Summary: A healthy 55-year-old male with vigorous physical daily training and exercise was admitted to the acute coronary syndrome emergency department. Shortly after admission, expert transthoracic echocardiography was performed. Computed tomography of the chest observed a large irregular hypodense tumor-like lesion in the bulbar aorta that was occasionally prolapsing into the left main coronary artery ostium and which corresponded to fibroelastoma. A few hours after admission, an emergency cardiac surgery was performed with the excision of a Valsalva sinus tumor (size 2 × 2 cm) located between the right and left coronary cusp of the aortic valve. Conclusions: Focus cardiac ultrasound should be performed for any acute coronary syndrome because of the possible Valsalva sinus fibroelastoma etiology. Its localization next to the left main coronary artery ostium is rare, and dangerous. The timely diagnosis can be made by the multimodality imaging method, however, the final diagnosis will be made pathohistologically. Early cardiac surgery may be a necessitated recourse for these patients in order to prevent a fatal outcome.
| S-EPMC8200485 | biostudies-literature
Project description:BackgroundAn aortic sinus of Valsalva aneurysm (SVA) often remains undiagnosed until it ruptures. An SVA filled with thrombus can be challenging to diagnose accurately.Case summaryA 70-year-old man was admitted with a clinical diagnosis of well-tolerated complete atrioventricular block (AVB). Transthoracic echocardiography revealed a spherical mass (43 × 49 mm) at the interatrial septum. Enhanced computed tomography (CT) showed a well-defined, hollow, and non-enhanced mass suggesting a cardiac tumour. However, 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) showed no uptake in the mass. After implantation of a permanent pacemaker, anticoagulant therapy was started for paroxysmal atrial fibrillation. Two months later, follow-up evaluation by echocardiography and enhanced CT revealed an increase in size of the hollow interior cavity, suggesting thrombolysis by the anticoagulant. We diagnosed a non-coronary SVA filled with thrombus, which masqueraded as a cardiac tumour and may have caused complete AVB.ConclusionsWe describe a rare case of a giant thrombosed SVA masquerading as a cardiac tumour. Initial 18F-FDG PET/CT and serial imaging studies were helpful in distinguishing it from a cardiac tumour.
| S-EPMC8374963 | biostudies-literature
Project description:Coronary artery anomalies are not uncommon. The importance of coronary anomalies varies from unimportant to life threatening. Herein, we report for the first time twin circumflex coronary arteries originating separately from the left sinus of Valsalva.
| S-EPMC3331635 | biostudies-other
Project description:A 54-year-old male with a history of unrepaired ventricular septal defect (VSD) suffered from easy fatigability on exertion. A Levine grade V/VI continuous murmur was auscultated. Transthoracic echocardiogram showed a ruptured sinus of Valsalva aneurysm (SVA) and a significant left-to-right shunting from the ascending aorta to the right ventricle (RV). In addition, a 36 mmHg of pressure gradient was observed between the inflow and outflow tract in the RV, suggesting double-chambered RV (DCRV). Cardiac catheterization also revealed 33 mmHg of the pressure gradient in the mid-potion of the RV, which was coincident with DCRV. A calculated pulmonary-to-systemic flow ratio was 3.0. Therefore, the patient was offered surgical repair of the ruptured SVA and VSD, which was successfully performed. During the surgery, an anomalous muscle band, which is usually the cause of DCRV, was not found, instead, a thickened RV free-wall due to the exposure of the left-to-right shunt flow, so-named jet lesion, was found. Therefore, surgical resection of the anomalous muscle band was not required. The protruded SVA toward the RV, the jet lesion, and the increased RV stroke volume, which could induce relative stenosis, were the causes of the unusual DCRV. <Learning objective: A mechanism of an unusual double-chambered right ventricle induced by ruptured sinus of Valsalva aneurysm (SVA) is as follows. One is a morphological stenosis in the right ventricle (RV) due to a protruded SVA toward the RV. The second is a jet lesion; a thickened RV wall induced by the exposure of the shunt flow from the ascending aorta. The third is a relative stenosis due to the increased stroke volume of the RV.>.
| S-EPMC7588484 | biostudies-literature
Project description:BackgroundDelayed coronary obstruction after transcatheter aortic valve implantation has been reported to occur more commonly after self-expandable aortic valve implantation than balloon-expandable valve.Case summaryAn 86-year-old woman treated by transcatheter self-expandable aortic valve implantation had acute coronary syndrome 3 months after the procedure. Emergent coronary angiography showed decreased blood flow in the left coronary artery. Balloon angioplasty between the valve frame and the left coronary cusp was performed, and her ischaemia resolved. Contrast-enhanced computed tomography showed a commissural post of the supra-annular valve overlying the left coronary cusp, and serial computed tomography showed the valve frame expanding over time. She received coronary bypass grafting using saphenous vein grafts for the left anterior descending and left circumflex arteries. Four months after surgery for the left anterior descending artery, the patient had recurrent chest pain, and computed tomography showed a graft occlusion in the left anterior descending artery. Shortly afterwards, she died of sudden cardiac arrest.DiscussionIn this report, we describe delayed Valsalva obstruction after transcatheter self-expandable aortic valve implantation, which can be detectable by serial computed tomography. The sealing of a coronary cusp by a commissural post of the valve may be one of the causes of delayed coronary ischaemia after transcatheter self-expandable aortic valve implantation.
| S-EPMC7891291 | biostudies-literature