Bilateral Sinus of Valsalva Aneurysms
An Extreme Case
A 55-year-old man with no significant cardiovascular risk factors presented with intermittent chest tightness on exertion as well as syncopal attacks of 3 months’ duration. Physical examination was unremarkable, and laboratory findings including troponin I levels were normal. The ECG did not show any ischemic changes apart from poor anterior R-wave progression. A chest radiograph showed mild cardiomegaly. An echocardiogram was performed that showed two large sinus of Valsalva aneurysms (Figure 1 and Movie I). These were confirmed by a contrast-enhanced, 16–multidetector-row computed tomography angiogram (Somatom 16, Siemens Medical Solutions, Erlangen, Germany) with retrospective ECG gating. Two giant sinus of Valsalva aneurysms of 7 cm maximum diameter were seen arising from the right and noncoronary sinuses. The aneurysms were compressing the right ventricle, right atrium, and left atrium. The ascending aorta was normal (Figure 2A through 2C and Movie II). The patient underwent surgical reconstruction of the aortic root to preserve the native aortic valve. However, perioperative bleeding around the Valsalva graft into the sinuses necessitated a formal aortic root replacement with a Shelhigh prosthesis as well as a right coronary bypass graft. A postoperative contrast-enhanced, ECG-gated computed tomography angiogram showed good appearance and size of the lumen of the ascending aorta graft and of the native left and grafted right coronary arteries. The dilated sinuses of Valsalva were thrombosed (Figure 3). The patient was discharged home 1 month later.
The online-only Data Supplement, which contains 2 movies, is available at http://circ.ahajournals.org/cgi/content/full/114/16/e542/DC1.