Institute of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica Del Sacro Cuore, Roma, Italy.
Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Anatomia Patologica, Università Cattolica Del Sacro Cuore, Rome, Italy.
Cardiovasc Pathol. 2020 Jul-Aug;47:107209. doi: 10.1016/j.carpath.2020.107209. Epub 2020 Feb 3.
Aneurysms in the sinuses of Valsalva (SVA) are the least frequent and occur due to a weakness in the aortic wall that forms part of the sinus. This causes dilatation and the formation of a blind pocket in one of the aortic sinuses (usually he right sinus and less frequently the posterior one). It may be congenital or acquired: in a congenital SVA, the condition is frequently associated with Marfan's syndrome or other connective tissue disorders; instead, acquired forms of sinus of Valsalva aneurysm are associated with infections (syphilis, bacterial endocarditis, and tuberculosis), atherosclerosis and medial cystic necrosis, traumatic and degenerative diseases, abuse of drugs or alcoholism. Despite SVA is a well-known anomaly, autopsy images or reviews of the condition are very uncommon. Indeed we report here a fatal case of SVA in a 58-year-old homeless man found dead on the street. The autopsy, performed to determine the cause of death, releaved a massive aneurysm (in excess of 4 cm) involving the right coronary sinus of the aorta. In this case, the aneurysm may be an accidental finding: in effect we found no tromboses inside the aneurysm and the ostium was not obstructed, therefore the cause of death could be attribuited to fatal arrhythmia.
瓦氏窦（Sinus of Valsalva）中的动脉瘤是最不常见的，发生于主动脉壁的薄弱部位，该部位构成窦的一部分。这会导致窦扩张并在其中一个主动脉窦（通常是右窦，较少见的是后窦）形成一个盲袋。它可能是先天性的或后天性的：在先天性 SVA 中，这种情况常与马凡综合征或其他结缔组织疾病有关；相反，后天性的瓦氏窦动脉瘤与感染（梅毒、细菌性心内膜炎和结核病）、动脉粥样硬化和中层囊性坏死、创伤和退行性疾病、药物滥用或酗酒有关。尽管 SVA 是一种众所周知的异常，但尸检图像或对该病的回顾非常少见。事实上，我们在此报告了一例 58 岁无家可归者的致命性 SVA 病例，该患者在街上被发现死亡。为确定死因而进行的尸检显示，主动脉右冠状动脉窦有一个巨大的动脉瘤（超过 4 厘米）。在这种情况下，动脉瘤可能是偶然发现的：实际上，我们在动脉瘤内部没有发现血栓，窦口也没有阻塞，因此死因可能归因于致命性心律失常。
