RESUMO
An 87-year-old woman underwent AVR (CEP 21 mm) for aortic stenosis at age 73 years. Fourteen years later, she was treated with antibiotics for mediastinal abscess, which showed a tendency to shrink and inflammation improved. At that time, no vegetation or aortic regurgitation was observed. Eight months later, the patient was brought to the emergency room with a complaint of respiratory distress. After close examination, a severe transvalvular leakage was found at the aortic valve position. No vegetation was found. Enhanced chest computed tomography (CT) showed an aneurysm of the left sinus of Valsalva. The diagnosis of healed aortic prosthetic valve endocarditis with an aneurysm of the sinus of Valsalva was made. The CEP valve was removed at surgery, and the valve leaflet corresponding to the right coronary cusp was destroyed. The left sinus of Valsalva was dilated and a Perceval was implanted. The patient was doing well postoperatively, but a pacemaker was implanted due to atrioventricular dissection. Transthoracic echocardiography confirmed that there was no problem with prosthetic valve function at the aortic valve position, and CT showed a reduction of aneurysm of the left sinus of Valsalva. The patient was discharged from the hospital on the 30th postoperative day. Aortic valve replacement with Perceval is effective in high-risk cases of prosthetic valve endocarditis.
RESUMO
Los aneurismas de los senos de Valsalva son malformaciones raras que pueden ser congénitas o adquiridas. La causa más común de los adquiridos es la endocarditis aórtica. Actualmente la ecocardiografía se ha convertido en el método diagnóstico de elección. Se presentan dos pacientes en edad pediátrica con aneurismas del seno de Valsalva no roto y manifestaciones de falla cardíaca secundaria a insuficiencia aórtica aguda. Se compararon las imágenes ecocardiográficas bidimensionales transtorácicas y transesofágicas y en uno de ellos tridimensionales, analizando la calidad de la imagen, localización y detalles anatómicos del aneurisma, obstrucción o compresión de estructuras adyacentes y la presencia de otros defectos asociados. Se demuestra la utilidad de la valoración ecocardiográfica tridimensional en el abordaje diagnóstico de estas lesiones.
Aneurysm of the sinus of Valsalva is a rare anomaly that can be congenital or acquire. The most common among the acquire is aortic endocarditis. At the present time echocardiography has be come the election diagnostic method. We present two pediatric patients with unrupture aneurysm of the sinus of Valsalva and cardiac failure secondary to a acute aortic insufficiency manifestations. Transthoracic and transesophageal bidimensional images were compared, in one of them also three-dimensional image. Assessing the quality of images, localization and anatomical morphology of aneurysm, obstruction or compression and presence of associated defects. The usefulness of the three dimensional echocardiography assessment for these congenital malformations is demonstrated. (Arch Cardiol Mex 2005; 75: 148-153).
Assuntos
Criança , Humanos , Masculino , Aneurisma Aórtico , Ecocardiografia Tridimensional , Seio Aórtico , Ecocardiografia Doppler em Cores , Ecocardiografia TransesofagianaRESUMO
Ruptured aneurysms of the sinus of Valsalva are relatively rare, and the incidence seems to be higher in oriental than in western countries. Valsalva sinus aneurysm consists of a separation or lack of fusion behveen the media of the aorta and the annus fibrosis of the aortic valve. Rupture usually occurs in the third or fourth decade of life, most often between the right coronary cusp and the right ventricle, but occasionally, when the noncoronary cusp is involved, the fistular drains into the right atrium. Abrupt rupture causes chest pain, bounding pulses, a continuous murmur, and volume overload of the heart. Associated cardiac lesions are common including VSD and AR. We experienced a typical case of ruptured aneurysm of the sinus of Valsalva into RA in a 31 year-old man presented sith sudden dyspnea, chest pain and palpitation. Diagnosis was made by 2D-echocardiography, cardiac catheterization and cine-angiogram. This case, the aneurysm was originated from the noncoronary sinus and ruptured into right atriurn. The ruptured aneurysm were repaired mth Dacron patch.