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. 1990;17(3):245–248.

Aneurysm of the Left Sinus of Valsalva

An Unusual Presentation

Neil E Hoganson 1, Aurel C Cernaianu 1, Jonathan H Cilley Jr 1, Anthony J Delrossi 1
PMCID: PMC324926  PMID: 15227180

Abstract

Unruptured aneurysms of the left sinus of Valsalva are extremely rare, and their clinical features are not well-documented in the literature. We describe an unusual case in which an unruptured aneurysm of the left sinus of Valsalva associated with previously undiagnosed Marfan syndrome caused extrinsic compression of the esophagus, resulting in dysphagia unrelated to the type or timing of meals. Our report focuses on the initial clinical presentation, as well as the diagnosis and management of this rare lesion. (Texas Heart Institute Journal 1990;17:245-8)

Keywords: Aorta

Keywords: aortic aneurysm

Keywords: echocardiography

Keywords: Marfan syndrome

Keywords: sinus of Valsalva

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Selected References

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  1. Bacon H. E., Pezzutti J. E. Adequate resection for diverticulitis of the colon. Arch Surg. 1966 Jan;92(1):58–59. doi: 10.1001/archsurg.1966.01320190060013. [DOI] [PubMed] [Google Scholar]
  2. Bentall H., De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 1968 Jul;23(4):338–339. doi: 10.1136/thx.23.4.338. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brandt J., Jögi P., Lührs C. Sinus of Valsalva aneurysm obstructing coronary arterial flow: case report and collective review of the literature. Eur Heart J. 1985 Dec;6(12):1069–1073. doi: 10.1093/oxfordjournals.eurheartj.a061811. [DOI] [PubMed] [Google Scholar]
  4. Come P. C., Fortuin N. J., White R. I., Jr, McKusick V. A. Echocardiographic assessment of cardiovascular abnormalities in the Marfan syndrome. Comparison with clinical findings and with roentgenographic estimation of aortic root size. Am J Med. 1983 Mar;74(3):465–474. doi: 10.1016/0002-9343(83)90984-1. [DOI] [PubMed] [Google Scholar]
  5. DeMaria A. N., Bommer W., Neumann A., Weinert L., Bogren H., Mason D. T. Identification and localization of aneurysms of the ascending aorta by cross-sectional echocardiography. Circulation. 1979 Apr;59(4):755–761. doi: 10.1161/01.cir.59.4.755. [DOI] [PubMed] [Google Scholar]
  6. EDWARDS J. E., BURCHELL H. B. The pathological anatomy of deficiencies between the aortic root and the heart, including aortic sinus aneurysms. Thorax. 1957 Jun;12(2):125–139. doi: 10.1136/thx.12.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. ELIOT R. S., WOLBRINK A., EDWARDS J. E. CONGENITAL ANEURYSM OF THE LEFT AORTIC SINUS. A RARE LESION AND A RARE CAUSE OF CORONARY INSUFFICIENCY. Circulation. 1963 Nov;28:951–956. doi: 10.1161/01.cir.28.5.951. [DOI] [PubMed] [Google Scholar]
  8. Engel P. J., Held J. S., van der Bel-Kahn J., Spitz H. Echocardiographic diagnosis of congenital sinus of Valsalva aneurysm with dissection of the interventricular septum. Circulation. 1981 Mar;63(3):705–711. doi: 10.1161/01.cir.63.3.705. [DOI] [PubMed] [Google Scholar]
  9. Faillace R. T., Greenland P., Nanda N. C. Rapid expansion of a saccular aneurysm on the left coronary sinus of Valsalva: a role for early surgical repair? Br Heart J. 1985 Oct;54(4):442–444. doi: 10.1136/hrt.54.4.442. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ferlic R. M., Goott B., Edwards J. E., Lillehei C. W. Aortic valvular insufficiency associated with cystic medial necrosis: surgical and pathologic considerations. Ann Surg. 1967 Jan;165(1):1–9. doi: 10.1097/00000658-196701000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fishbein M. C., Obma R., Roberts W. C. Unruptured sinus of Valsalva aneurysm. Am J Cardiol. 1975 Jun;35(6):918–922. doi: 10.1016/0002-9149(75)90129-0. [DOI] [PubMed] [Google Scholar]
  12. Fox R., Ren J. F., Panidis I. P., Kotler M. N., Mintz G. S., Ross J. Anuloaortic ectasia: a clinical and echocardiographic study. Am J Cardiol. 1984 Jul 1;54(1):177–181. doi: 10.1016/0002-9149(84)90325-4. [DOI] [PubMed] [Google Scholar]
  13. Francis G. S., Hagan A. D., Oury J., O'Rourke R. A. Accuracy of echocardiography for assessing aortic root diameter. Br Heart J. 1975 Apr;37(4):376–378. doi: 10.1136/hrt.37.4.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Gallet B., Combe E., Saudemont J. P., Tetard C., Barret F., Gandjbakhch I., Hiltgen M. Aneurysm of the left aortic sinus causing coronary compression and unstable angina: successful repair by isolated closure of the aneurysm. Am Heart J. 1988 Jun;115(6):1308–1310. doi: 10.1016/0002-8703(88)90028-2. [DOI] [PubMed] [Google Scholar]
  15. Gramiak R., Shah P. M. Echocardiography of the aortic root. Invest Radiol. 1968 Sep-Oct;3(5):356–366. doi: 10.1097/00004424-196809000-00011. [DOI] [PubMed] [Google Scholar]
  16. Henze A., Huttunen H., Björk V. O. Ruptured sinus of valsalva aneurysms. Scand J Thorac Cardiovasc Surg. 1983;17(3):249–253. doi: 10.3109/14017438309099360. [DOI] [PubMed] [Google Scholar]
  17. Hiyamuta K., Ohtsuki T., Shimamatsu M., Ohkita Y., Terasawa M., Bekki H., Toshima H., Utsu F., Ohishi K., Koga M. Aneurysm of the left aortic sinus causing acute myocardial infarction. Circulation. 1983 May;67(5):1151–1154. doi: 10.1161/01.cir.67.5.1151. [DOI] [PubMed] [Google Scholar]
  18. Jansen E. W., Nauta I. L., Lacquet L. K. Ruptured aneurysms of the sinus Valsalvae. Thorac Cardiovasc Surg. 1984 Jun;32(3):148–151. doi: 10.1055/s-2007-1023372. [DOI] [PubMed] [Google Scholar]
  19. Kovacs R. J. 33-year-old man with shortness of breath and chest pain. Indiana Med. 1986 Jul;79(7):610–616. [PubMed] [Google Scholar]
  20. Martin L. W., Hsu I., Schwartz H., Wasserman A. G. Congenital aneurysm of the left sinus of Valsalva. Report of a patient with 19-year survival without surgery. Chest. 1986 Jul;90(1):143–145. doi: 10.1378/chest.90.1.143. [DOI] [PubMed] [Google Scholar]
  21. Mattleman S., Panidis I., Kotler M. N., Mintz G., Victor M., Ross J. Dissecting aneurysm in a patient with Marfan's syndrome: recognition of extensive involvement of the aorta by two-dimensional echocardiography. J Clin Ultrasound. 1984 May;12(4):219–221. doi: 10.1002/jcu.1870120409. [DOI] [PubMed] [Google Scholar]
  22. Mayer E. D., Ruffmann K., Saggau W., Butzmann B., Bernhardt-Mayer K., Schatton N., Schmitz W. Ruptured aneurysms of the sinus of Valsalva. Ann Thorac Surg. 1986 Jul;42(1):81–85. doi: 10.1016/s0003-4975(10)61842-5. [DOI] [PubMed] [Google Scholar]
  23. Mayer J. E., Jr, Lindsay W. G., Wang Y., Jorgensen C. R., Nicoloff D. M. Composite replacement of the aortic valve and ascending aorta. J Thorac Cardiovasc Surg. 1978 Dec;76(6):816–823. [PubMed] [Google Scholar]
  24. Meyer J., Wukasch D. C., Hallman G. L., Cooley D. A. Aneurysm and fistula of the sinus of Valsalva. Clinical considerations and surgical treatment in 45 patients. Ann Thorac Surg. 1975 Feb;19(2):170–179. doi: 10.1016/s0003-4975(10)63999-9. [DOI] [PubMed] [Google Scholar]
  25. Murdoch J. L., Walker B. A., Halpern B. L., Kuzma J. W., McKusick V. A. Life expectancy and causes of death in the Marfan syndrome. N Engl J Med. 1972 Apr 13;286(15):804–808. doi: 10.1056/NEJM197204132861502. [DOI] [PubMed] [Google Scholar]
  26. Norwicki E. R., Aberdeen E., Friedman S., Rashkind W. J. Congenital left aortic sinus-left ventricle fistula and review of aortocardiac fistulas. Ann Thorac Surg. 1977 Apr;23(4):378–388. doi: 10.1016/s0003-4975(10)64149-5. [DOI] [PubMed] [Google Scholar]
  27. Olsen J. Aneurysm of the aortic sinus of Valsalva. A case of rupture and myocardial infarction. Acta Pathol Microbiol Scand. 1969;76(1):12–18. doi: 10.1111/j.1699-0463.1969.tb03227.x. [DOI] [PubMed] [Google Scholar]
  28. Pan-Chih, Ching-Heng T., Chen-Chun, Chieh-Fu L. Surgical treatment of the ruptured aneurysm of the aortic sinuses. Ann Thorac Surg. 1981 Aug;32(2):162–166. doi: 10.1016/s0003-4975(10)61024-7. [DOI] [PubMed] [Google Scholar]
  29. Roberts W. C. Congenital cardiovascular abnormalities usually "silent" until adulthood: morphologic features of the floppy mitral valve, valvular aortic stenosis, discrete subvalvular aortic stenosis, hypertrophic cardiomyopathy, sinus of Valsalva aneurysm, and the Marfan syndrome. Cardiovasc Clin. 1979;10(1):407–453. [PubMed] [Google Scholar]
  30. Sanchez H. E., Barnard C. N., Barnard M. S. Fistula of the sinus of Valsalva. J Thorac Cardiovasc Surg. 1977 Jun;73(6):877–879. [PubMed] [Google Scholar]
  31. Taguchi K., Sasaki N., Matsuura Y., Uemura R. Surgical correction of aneurysm of the sinus of Valsalva. A report of forty-five consecutive patients including eight with total replacement of the aortic valve. Am J Cardiol. 1969 Feb;23(2):180–191. doi: 10.1016/0002-9149(69)90065-4. [DOI] [PubMed] [Google Scholar]
  32. Tanabe T., Yokota A., Sugie S. Surgical treatment of aneurysms of the sinus of Valsalva. Ann Thorac Surg. 1979 Feb;27(2):133–136. doi: 10.1016/s0003-4975(10)63253-5. [DOI] [PubMed] [Google Scholar]
  33. Vargas-Barron J., Keirns C., Attie F., Gil-Moreno M., Aracil C. Congenital aneurysm of sinus of Valsalva detected by pulsed Doppler echocardiography. Am Heart J. 1986 Jan;111(1):181–184. doi: 10.1016/0002-8703(86)90574-0. [DOI] [PubMed] [Google Scholar]
  34. WHEAT M. W., Jr, WILSON J. R., BARTLEY T. D. SUCCESSFUL REPLACEMENT OF THE ENTIRE ASCENDING AORTA AND AORTIC VALVE. JAMA. 1964 May 25;188:717–719. doi: 10.1001/jama.1964.03060340015004. [DOI] [PubMed] [Google Scholar]
  35. Williams T. G., Williams B. T. Isolated unruptured aneurysm of the left coronary sinus of Valsalva. Ann Thorac Surg. 1983 May;35(5):556–559. doi: 10.1016/s0003-4975(10)60435-3. [DOI] [PubMed] [Google Scholar]

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