Pulmonary sinus of Valsalva aneurysm: A rare entity | |
DOI: 10.5606/e-cvsi.2017.595 | |
Trushar Gajjar, Nageswar Rao, Neelam Desai | |
Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, CTVS Department, Prasanthigram, Andhra Pradesh, India | |
Keywords: Pulmonary sinus of Valsalva aneurysm; pulmonary valve; sinus of Valsalva aneurysm | |
Pulmonary sinus of Valsalva aneurysm is rare. An intrinsic weakness of the wall and increased hemodynamic stress is the main causative
factor. Surgery has a definite role. Herein, we describe a case of pulmonary sinus of Valsalva aneurysm who was successfully treated in
our clinic. |
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Pulmonary artery sinus of Valsalva aneurysm
is an unusual lesion,[1-4] which can be associated
with congenital heart diseases, pulmonary artery
hypertension, pulmonary valve stenosis, connective
tissue diseases (such as Marfan syndrome), and
vasculitis. To the best of our knowledge, true pulmonary
sinus of Valsalva aneurysm with a dilated pulmonary
artery has not been reported in the literature. Herein,
we describe a case of pulmonary sinus of Valsalva
aneurysm who was successfully treated in our clinic. |
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CASE PRESANTATION
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A five-month-old boy presented with a complaint
of recurrent respiratory tract infection. Chest X-ray
showed a dilated pulmonary artery (Figure 1).
Echocardiography showed a large perimembranous
ventricular septal defect (VSD), large-sized patent
ductus arteriosus (PDA), a dilated main pulmonary
artery and branches. Cardiac catheterization showed a
right ventricular systolic and mean pulmonary artery
pressure of 67 mmHg and 43 mmHg, respectively,
and a left-to-right shunt at a ratio of 2.1:1 and a
pulmonary vascular resistance index of 2.4 Woods units.
Angiography showed a dilated pulmonary artery with
an aneurysm of the anterior sinus of Valsalva (Figure 2).
The patient underwent a successful closure of VSD and
PDA with plication of the sinus of Valsalva aneurysm
(Figure 3, 4). The post operative course in the hospital
was uneventful and was discharged in stable condition
on sixth postoperative day. Figure 1. A chest X-ray image showing a dilated pulmonary artery with plethora. Figure 4. An intraoperative view showing repaired aneurysm of sinus of Valsalva. |
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In the literature review, true pulmonary sinus of
Valsalva aneurysm is rare and unusual lesion.[1-4]
This anomaly can be seen with associated with congenital heart disease, pulmonary arterial
hypertension, valvar pulmonary stenosis, connective
tissue disorders and vasculitis. Other causes include
infections (i.e., tuberculosis, syphilis), atherosclerosis,
hypertension, hereditary hemorrhagic telangiectasia,
cystic media necrosis, and traumas.[1] The pathological cause is intrinsic weaknesses of the arterial wall
in combination with an increased hemodynamic
stress are responsible for its formation.[2-4] The
clinical manifestations are mostly non-specific and
symptoms are usually due to associated lesions.[2]
Cardiac catheterization and angiography are the
gold standards for the diagnosis; however, noninvasive
imaging methods including spiral computed
tomography angiography and magnetic resonance
imaging are also useful tools.[3,4] Surgical intervention
is often recommended to symptomatic patients and
to those with underlying diseases or complications,
left-to-right shunts, pulmonary arterial hypertension,
and large-sized aneurysms.[4] In the treatment of lowpressure
pulmonary artery aneurysms, intervention
is required when the right ventricular size and
function alter due to pulmonary regurgitation or
pulmonary stenosis. However, asymptomatic, smallsized
aneurysms need close follow-up, as the risk
of rupture is low, while these lesions requires an
intervention if patient is undergoing open heart
surgery for associated lesion.[4] In conclusion, pulmonaty sinus of Valsalva aneurysm is an unusual entity mostly associated with other congenital anomaly. The weakness of arterial wall with increased hemodynamic stress leads to this anomaly. Diagnosis can be achieved by conventional echocardiography and angiography. The computed tomography angiography and magnetic resonance imaging helps in better delineation of anatomy. Small and asymptomatic aneurysm needs observation while associated congenital heart disease and large aneurysm needs surgical intervention.
Declaration of conflicting interests
Funding |
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1) Bartter T, Irwin RS, Nash G. Aneurysms of the pulmonary
arteries. Chest 1988;94:1065-75.
2) Butto F, Lucas RV Jr, Edwards JE. Pulmonary arterial aneurysm.
A pathologic study of five cases. Chest 1987;91:237-41.
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