ABSTRACT
BACKGROUND: Myocardial dissection (MD) in a left sinus of Valsalva aneurysm (LSVA) is a rare condition that may lead to a fatal complication. Determining the MD etiology is challenging because of various possibilities ranging from congenital to acquired diseases. Here, we discuss an approach for determining the etiology of MD complicating LSVA in Takayasu arteritis (TA) and its treatment. CASE PRESENTATION: A 41-year-old man presented with dyspnea on heavy activities and a history of consciousness loss at the age of 24 years. He was diagnosed with dilated cardiomyopathy and MD complicating LSVA in TA based on combined clinical and pathognomonic diagnostic criteria of TA evaluated using vascular Doppler and computed tomography angiography of the aorta. The patient refused to undergo surgery and received an optimal dose of chronic heart failure therapy, a high-dose steroid, and azathioprine. The patient experienced some improvements in clinical condition, functional outcome, and inflammatory markers at 1-year follow-up. CONCLUSIONS: Clinical criteria and various imaging modalities may be used to determine the etiology of MD complicating LSVA in silent TA. As an alternative to surgery, the optimal medical treatment might result in a satisfactory outcome.
Subject(s)
Aortic Aneurysm/complications , Aortic Dissection/etiology , Cardiomyopathy, Dilated/complications , Sinus of Valsalva , Takayasu Arteritis/complications , Adult , Aortic Dissection/diagnostic imaging , Aortic Dissection/drug therapy , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/drug therapy , Azathioprine/therapeutic use , Cardiomyopathy, Dilated/diagnostic imaging , Cardiomyopathy, Dilated/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Male , Myocardium/pathology , Sinus of Valsalva/diagnostic imaging , Steroids/therapeutic use , Takayasu Arteritis/diagnostic imaging , Takayasu Arteritis/drug therapy , Treatment OutcomeABSTRACT
We report a case of left sinus of Valsalva aneurysm rupture into main pulmonary artery who underwent successful surgical correction. The preoperative diagnosis was facilitated by echocardiography, cardiac catheterization, and computed tomography. The benefits of surgery are sustained at 8 months on clinical and angiographic follow-up.
ABSTRACT
A 76-year-old woman was admitted to our hospital because of sudden onset of chest pain and dyspnea. Echocardiography, chest CT, and cardiac catheterization revealed an isolated extracardiac unruptured left sinus of Valsalva aneurysm, with stenosis of the main trunk of the left coronary artery. Neither aortic regurgitation nor aortic annular dilatation was recognized. As an infection associated sinus of Valsalva aneurysm could not be ruled out, we performed patch closure using autologous pericardium and coronary artery bypass grafting to the left coronary system. The postoperative course was uneventful. One year after the operation, CT revealed that aneurysm of the left sinus of Valsalva had disappeared and that the grafts were patent.
ABSTRACT
Sinus of Valsalva aneurysm is a rare cardiac disorder, and reports of its origin among in the left sinus are scarce. This report describes a 38-year-old man with an isolated extracardiac unruptured aneurysm of the left sinus of Valsalva. The patient presented with chest pain due to compression of the main trunk of the left coronary artery by the aneurysm. The aneurysm was resected, and the aortic root was reconstructed using the Bentall procedure. Concomitantly, coronary artery bypass grafting (LITA-LAD) was added. Postoperative native coronary flow was fully restored, and his anginal symptoms disappeared despite occlusion of the additional LITA-LAD anastomosis. This type of case would be considered to not require concomitant CABG, since the cause of the coronary artery stricture was compression by an aneurysm in the left sinus of Valsalva.
