Pichard S, Grinda J-M, Duclos F
Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, centre hospitalier d'Argenteuil, hôpital Victor Dupouy, 69, rue du Lieutenant Colonel Prudhon, 95100 Argenteuil, France.
Service de chirurgie cardiaque, clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France.
Ann Cardiol Angeiol (Paris). 2018 Nov;67(5):388-393. doi: 10.1016/j.ancard.2018.08.001. Epub 2018 Sep 7.
A 26-year-old woman of Cap Verdean origin was admitted to emergency unit with chest pain and dyspnea. Because of sinus tachycardia without any other electrocardiogram abnormalities, high NT-pro BNP level, and weakly positive cardiac troponin I and D-dimer levels, an aortic and pulmonary non ECG-gated CT-angiography was performed that excluded pulmonary embolism and aortic dissection. Transthoracic echocardiography (TTE) showed a contained rupture of the non-coronary sinus of Valsalva aneurysm sized 23 to 24mm into the right atrium. According to the high rupture risk, patient had been immediately transferred in a cardiologic surgical center where transesophageal echocardiography (TEE) and thoracic angiography ECG-gated Multiple Detector Computerized Tomography (ECG-gated MDCT) reinforced the diagnosis. Patient underwent surgical repair resection of the aneurysmal sac, which was described as "tissue paper thin" and at risk for impending rupture, without evidence of communication between the aorta and the right atrium. Anatomopathological examination described a thick sclerotic and oedematous aneurysm wall without inflammation, and bacteriological examination was negative. It is a rare case of contained rupture of the congenital non-coronary sinus of Valsalva aneurysm into the right atrium (Type IV of Sakakibara classification), with a high rupture risk. This case shows that the use ECG-gated-MDCT is more appropriate when aortic dissection is suspected, allowing a detailed analysis of aorta, especially the proximal portion which is more susceptible to motion artifacts.
一名26岁的佛得角裔女性因胸痛和呼吸困难被收入急诊室。由于窦性心动过速且无其他心电图异常、NT-pro BNP水平升高、心肌肌钙蛋白I和D-二聚体水平弱阳性，遂进行了主动脉和肺动脉非心电图门控CT血管造影，排除了肺栓塞和主动脉夹层。经胸超声心动图（TTE）显示一个大小为23至24毫米的瓦氏窦非冠状窦瘤破裂并包绕在右心房内。鉴于破裂风险高，患者立即被转至心脏外科中心，经食管超声心动图（TEE）和胸部血管造影心电图门控多层螺旋计算机断层扫描（ECG门控MDCT）进一步确诊。患者接受了瘤囊的手术修复切除，瘤囊被描述为“薄如纸巾”且有即将破裂的风险，主动脉与右心房之间无交通迹象。解剖病理学检查显示动脉瘤壁增厚、硬化且水肿，无炎症，细菌学检查为阴性。这是一例先天性瓦氏窦非冠状窦瘤破裂并包绕在右心房内的罕见病例（Sakakibara分类IV型）且破裂风险高。该病例表明，当怀疑主动脉夹层时，使用ECG门控MDCT更为合适，它能对主动脉进行详细分析，尤其是更易出现运动伪影影响的近端部分。
