Mhanna Mohammed, Beran Azizullah, Nesheiwat Zeid, Eid Joseph, Alom Modar, Grande Robert
Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
Cardiovasc Revasc Med. 2022 Jul;40S:325-328. doi: 10.1016/j.carrev.2021.11.041. Epub 2021 Dec 4.
Sinus of Valsalva aneurysm (SOVA) is a rare cardiac defect. In most cases, SOVA presents as an incidental finding during cardiac imaging. A dreadful complication of SOVA is spontaneous rupture, most commonly occurring into the right side of the heart resulting in an abrupt or insidiously progressive congestive heart failure. Ruptured SOVA is associated with poor prognosis with high mortality unless timely surgical intervention is deemed. We present a 23-year-old female who presented with a continuous heart murmur and exertional dyspnea. Transesophageal echocardiogram showed a ruptured 1.8 cm sinus of Valsalva aneurysm of the non-coronary cusp to the right ventricle, which resulted in a significant left-to-right shunt and pulmonary hypertension. Associated cardiac defects included ostium secundum atrial septal defect, peri-membranous ventricular septal defect, and moderate aortic and mitral valve insufficiency. The patient underwent successful surgical correction with significant resolution of the shunt and normalization of the pulmonary pressure. Despite being rare, SOVA can rupture spontaneously, resulting in decompensated heart failure. SOVA should be considered in the differential diagnosis of a continuous heart murmur. Early recognition and timely surgical intervention are pivotal in these cases to prevent further clinical deterioration or even death. LEARNING POINTS: Sinus of Valsalva aneurysms (SOVA) are usually silent until acute rupture. Rupture most commonly occurs into either the right ventricle or right atrium. A new continuous murmur is the most striking physical finding; it is always significant and must prompt urgent echocardiography to facilitate timely diagnosis and treatment. Ruptured SOVA has a poor prognosis with high mortality unless timely surgical intervention is deemed.
瓦氏窦瘤（SOVA）是一种罕见的心脏缺陷。在大多数情况下，SOVA是在心脏成像时偶然发现的。SOVA的一种可怕并发症是自发破裂，最常见的是破裂进入心脏右侧，导致急性或隐匿性进行性充血性心力衰竭。除非进行及时的手术干预，否则破裂的SOVA预后较差，死亡率较高。我们报告一名23岁女性，她表现为持续性心脏杂音和劳力性呼吸困难。经食管超声心动图显示非冠状动脉瓣叶的1.8厘米瓦氏窦瘤破裂至右心室，导致明显的左向右分流和肺动脉高压。相关的心脏缺陷包括继发孔房间隔缺损、膜周部室间隔缺损以及中度主动脉瓣和二尖瓣关闭不全。该患者接受了成功的手术矫正，分流明显缓解，肺动脉压力恢复正常。尽管罕见，但SOVA可自发破裂，导致失代偿性心力衰竭。在持续性心脏杂音的鉴别诊断中应考虑SOVA。在这些病例中，早期识别和及时的手术干预对于防止进一步的临床恶化甚至死亡至关重要。学习要点：瓦氏窦瘤（SOVA）通常在急性破裂前无症状。破裂最常见于右心室或右心房。新出现的持续性杂音是最显著的体格检查发现；它总是有意义的，必须促使紧急进行超声心动图检查以促进及时诊断和治疗。除非进行及时的手术干预，否则破裂的SOVA预后较差，死亡率较高。
