Sharma Shubham, Shah Jayal, Charaniya Riyaz, Dash Rakesh
Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad 380016, Gujarat, India.
Eur Heart J Case Rep. 2024 Aug 20;8(8):ytae417. doi: 10.1093/ehjcr/ytae417. eCollection 2024 Aug.
Ruptured sinus of Valsalva (RSOV) is a rare disorder, which usually involves the right coronary sinus (RCS) or the non-coronary sinus (NCS) and ruptures usually into the right-sided chambers. Involvement of the left coronary sinus (LCS) and multiple sinuses, rupture into the left ventricle (LV), and dissecting aneurysm of the interventricular septum (IVS) have all been scarcely reported.
A 24-year-old male presented with complaints of exertional fatigue, palpitations, and chest pain with signs of aortic run-off like wide pulse pressure, collapsing pulse along with cardiomegaly, and a diastolic murmur. Echocardiography revealed sinus of Valsalva aneurysms (SOVAs) involving both the RCS and LCS with RCS aneurysm dissecting the IVS and rupturing into the LV and another multilobulated aneurysm from LCS rupturing into the LV. Findings were confirmed on computed tomography (CT) aortogram, and the patient underwent successful surgical repair.
Sinus of Valsalva aneurysm is a rare disorder which usually ruptures into the right-sided chambers. The involvement of multiple sinuses and rupture into the IVS is extremely rare (<2%). Aneurysm dissecting the IVS can lead to complete heart block (CHB) and sudden death. Involvement of the LCS is reported in <5% cases of RSOV, and rupture of such an aneurysm into the pericardial space may lead to cardiac tamponade and can also lead to sudden death. Clinical examination, electrocardiogram, chest X-ray, 2D echocardiography, and CT all help in the diagnosis. Treatment involves surgical repair of the defect.
瓦氏窦破裂（RSOV）是一种罕见疾病，通常累及右冠状动脉窦（RCS）或无冠状动脉窦（NCS），且破裂通常进入右侧心腔。左冠状动脉窦（LCS）受累、多个窦受累、破裂进入左心室（LV）以及室间隔（IVS）夹层动脉瘤均鲜有报道。
一名24岁男性因劳力性疲劳、心悸和胸痛就诊，伴有主动脉分流体征，如脉压增宽、水冲脉，同时伴有心脏扩大及舒张期杂音。超声心动图显示瓦氏窦瘤（SOVA）累及RCS和LCS，RCS动脉瘤夹层累及IVS并破裂进入LV，另一个来自LCS的多叶状动脉瘤破裂进入LV。计算机断层扫描（CT）主动脉造影证实了这些发现，患者接受了成功的手术修复。
瓦氏窦瘤是一种罕见疾病，通常破裂进入右侧心腔。多个窦受累及破裂进入IVS极为罕见（<2%）。动脉瘤夹层累及IVS可导致完全性心脏传导阻滞（CHB）和猝死。RSOV病例中LCS受累的报道<5%，此类动脉瘤破裂进入心包腔可能导致心脏压塞，也可导致猝死。临床检查、心电图、胸部X线、二维超声心动图和CT均有助于诊断。治疗包括对缺损进行手术修复。
