Atrial septal aneurysms are localized, bulging malformations that protrude into the right or left atrium. This malformation can be associated with patent foramen ovale PFO , atrial septal defects ASD or multiple defects, and is considered a risk factor for stroke. In this study, we analyze results of treatment of this malformation with Amplatzer occluder devices. The procedure was performed under general anesthesia and transesophageal monitoring. Patients with PFO were injected with 5 ml of shaken saline solution in the inferior cava to show presence of right to left shunt Figure 1 and this was repeated during an intermittent positive pressure maneuver performed by the anesthetist.
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Spontaneous rupture of an aneurysm of the sinus of Valsalva into the right atrium, associated with an atrial septal aneurysm. Corresponding author: Nilda Espinola Zavaleta. Institute Nacional de Cardiologia Ignacio Chavez. Received on November 26, ; Accepted on March 29, Aneurysms of the sinus of Valsalva SV and the atrial septum are a rare association.
The presence of rupture of the right SV to the right atrium was clinically confirmed, by echocardiography and hemodynamic studies. In addition, an associated atrial septal aneurysm was found. She underwent surgical correction through sinusplasty without requiring aortic valve replacement. The patient presented persistent postoperative atrioventricular block, which required a permanent pacemaker.
Clinical evolution was satisfactory. To our knowledge, this case is a rare combination of two isolated malformations, without previous events that could explain the rupture of the right SV. Keywords: Sinus of Valsalva; Atrial septal aneurysm; Spontaneous rupture; Association of two isolated malformations; Echocardiography; Aortography; Mexico.
Un hallazgo interesante fue la presencia de un aneurisma del septum interauricular asociado. The electrocardiogram showed tachycardia and incomplete right bundle branch block. The place of rupture was shown with color flow imaging, revealing a unidirectional continuous mosaic jet from the aorta to the right heart chamber, Figure 1A, 1B.
In a four chamber view with posterior angulation, an interatrial septal aneurysm Figure 2 with a 19 mm base and an 11 mm right excursion beyond the plane of the atrial septum was found. No association with patent foramen ovale was observed with agitated saline solution baseline and Valsalva maneuver. This defect had all the features to be deemed an aneurysm, the cutoff criteria reported in an autopsy study by Silver and Dorsey 1 was used.
Cardiac catheterization with contrast medium injected into the ascending aorta showed shunting from the right sinus of Valsalva to the right atrium Figure 3. Oximetries and pressure in this cavity were increased. Surgical closure of the communication was performed under extracorporeal circulation.
The aortotomy showed the sinus of Valsalva aneurysm's origin in the right coronary sinus. The right atrium was open and the aneurysm's coat was seen, including the basal and medium portion of the interventricular septum.
Resection of the aneurysm's coat was made and replaced with a 1. Aortic valve replacement was not considered necessary. Laboratory tests searching for connective tissue disease were negative. In the early postoperative period, the patient developed variable degrees of atrioventricular block, and a definite VVI pacemaker was implanted. Aneurysm of the sinus of Valsalva ASV is a rare cardiac abnormality, occurring in 0.
They may be congenital or acquired. A congenital aneurysm is caused by separation or failed fusion of the aortic media layer with the fibrous annulus of the aortic valve. Acquired aneurysm of sinus of Valsalva can develop as the result of traumatic injury, 2 endocarditis, 3 syphilis, 4 Behcet's disease 5 or Marfan's syndrome.
The first reports of ASV appeared in the 19 th century and Lillehei et al. Aneurysms are generally silent for prolonged periods of time. Regarding complications, the most frequent occurrence is rupture. It occurs in most cases between the third and fourth decades of life. This wide variety in initial clinical presentations can be due to the size of the shunt; little shunts are asymptomatic, and big aortocardiac fistulas cause a clinical presentation similar to an acute aortic regurgitation.
There are numerous complications that can originate from a Valsalva aneurysm, including obstruction of the right ventricular outflow tract, infectious endocarditis, and thrombus formation, with systemic or local embolic events. Ischemia has been reported as a conditioning factor for ventricular fibrillation in some patients.
In this case, complete atrioventricular block usually accompanies the clinical presentation. Aneurysms are most frequently localized at the right sinus of Valsalva Eventhough the first report of a Valsalva aneurysm diagnosed by echocardiography was in , 12 currently the gold standard for the diagnosis of these lesions continues to be cardiac catheterization with aortography.
Development of new generation ultrasonography machines has made transthoracic and, especially, the transesophageal echocardiography a useful tool in the confirmation of the diagnosis. Nuclear magnetic resonance imaging is equally useful, 14 but more expensive and less available than echocardiography. The latter is a better and faster diagnostic tool, especially when dealing with critically ill patients.
Other associated abnormalities less frequently found are pulmonary stenosis, patent ductus arteriosus, atrial septal defect, subaortic stenosis, and Fallot's Tetralogy. Regarding the atrial septal aneurysm, 1,15 this is an infrequent finding in adult patients. However, it has been found also in patients with normal atrial pressure, 15 suggesting a primary malformation.
The coexistence of sinus of Valsalva aneurysms and atrial septal aneurysms is very rare. Atrial septal aneurysm is believed to be a disorder of connective tissue, 17 which is manifested along time in adults. In fact, connective tissue abnormalities must be suspected when both defects coexist together. Replacement of the valve was not considered necessary in the absence of aortic valve dysfunction.
We consider that the presence of this block was secondary to the inflammatory process of the surgery. The present case illustrates the rare coexistence of two congenital malformations, as are sinus of Valsalva aneurysm and aneurysm of the interatrial septum. Aneurysm of the septum primum in adults. Traumatic sinus of Valsalva fistula and aortic valve rupture. Shumacker HB Jr. Aneurysm of aortic sinuses of Valsalva due to bacterial endocarditis, with special reference to their operative management.
Smith WA. Aneurysm of sinus of Valsalva with report of two cases. J Am Med Assoc ; Ruptured aneurysm of the sinus of Valsalva in a patient with Behcet's disease. Surgical treatment of ruptured aneurysms of the sinus of Valsalva. Congenital aneurysm of the sinus of Valsalva. Isolated aneurysm of the left sinus of Valsalva. Rupture into the left atrium, left ventricle and dynamic coronary constriction.
Echocardiographic diagnosis of congenital sinus of Valsalva aneurysm with dissection of the interventricular septum. Ruptured aneurysm of the sinus of Valsalva in oriental patients.
Echocardiographic manifestation of the right sinus of Valsalva aneurysm. Congenital sinus of Valsalva aneurysm: a multiplane transesophageal experience.
Echocardiography and magnetic resonance imaging of a sinus of Valsalva aneurysm with rupture into the ventricle. Aneurysm of the atrial septum as diagnosed by echocardiography: analysis of 11 patients. Atrial septal aneurysm in adult patient. Ruptured aneurysm of the sinus of Valsalva associated with an atrial septal aneurysm. Servicios Personalizados Revista. Similares en SciELO. Abstract Aneurysms of the sinus of Valsalva SV and the atrial septum are a rare association. References 1.
2007, Número 1
Introduction: The aim of this study was to evaluate the systolic function of the left atrial appendage LAA in a group with and without patent foramen ovale PFO who suffered ischemic cerebrovascular events. Material and methods: Between September and October , 17 patients were referred for transesophageal echocardiography TEE after suffering a stroke. PFO was defined as the passage of at least one bubble through atrial septum with bubble test. We compared systolic velocity in the appendage between patients with and without PFO and a control group.
Spontaneous rupture of an aneurysm of the sinus of Valsalva into the right atrium, associated with an atrial septal aneurysm. Corresponding author: Nilda Espinola Zavaleta. Institute Nacional de Cardiologia Ignacio Chavez. Received on November 26, ; Accepted on March 29, Aneurysms of the sinus of Valsalva SV and the atrial septum are a rare association. The presence of rupture of the right SV to the right atrium was clinically confirmed, by echocardiography and hemodynamic studies. In addition, an associated atrial septal aneurysm was found.
Aneurisma del septum Interauricular. Olivares-Reyes, Al-Kamme A. El aneurisma septal atrial: Un estudio en pacientes adultos. Atrial Septal Aneurysm: A new classification in adults. J Am Soc Echocardiogr ; Brand A, Keren A.