巨大未破裂的瓦氏窦动脉瘤引起心绞痛。
Giant unruptured sinus of Valsalva aneurysms causing angina pectoris.
机构信息
Department of Cardiovascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, P.R. China.
Department of Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China.
出版信息
J Cardiothorac Surg. 2024 Apr 20;19(1):251. doi: 10.1186/s13019-024-02730-x.
BACKGROUND
Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly which can be congenital or acquired. Patients with SVA are commonly asymptomatic when the occupying effect of SVA is insignificant, while ruptured SVA usually causes severe symptoms including heart failure and myocardial ischemia.
CASE PRESENTATION
We present an unusual case of a 64-year-old female manifesting with exertional dyspnea as well as angina pectoris for three months. Echocardiography and cardiac computed tomographic angiography confirmed unruptured left-coronary and non-coronary SVAs. The left anterior descending artery and left circumflex artery were stretched and compressed by the SVA which causing myocardial ischemia. The patient finally received aortic root replacement (Bentall procedure) and got symptom relieved.
CONCLUSIONS
Giant unruptured SVA originating from left coronary sinus is extremely rare. Our case highlights that giant SVA should be considered in cases with angina pectoris. Echocardiography and coronary computed tomographic angiography are useful and important for diagnosis. Surgery is highly recommended in patients with SVA.
背景
瓦氏窦动脉瘤（SVA）是一种罕见的心脏异常，可分为先天性或后天性。当 SVA 的占位效应不明显时，SVA 患者通常无症状，而破裂的 SVA 通常会导致严重症状，包括心力衰竭和心肌缺血。
病例介绍
我们报告了一例不常见的病例，一名 64 岁女性表现为劳力性呼吸困难和心绞痛三个月。超声心动图和心脏计算机断层血管造影证实为未破裂的左冠状动脉窦和非冠状动脉 SVA。SVA 拉伸和压迫了前降支和左旋支，导致心肌缺血。患者最终接受了主动脉根部置换术（Bentall 手术），症状得到缓解。
结论
起源于左冠状动脉窦的巨大未破裂 SVA 极为罕见。我们的病例强调，对于心绞痛患者应考虑巨大 SVA。超声心动图和冠状动脉计算机断层血管造影对诊断很有用且重要。对于 SVA 患者，强烈推荐手术治疗。
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