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[Rupture of the left sinus of Valsalva forming a subepicardial pseudoaneurysm]
V Barbosa1, L Kopel, S A Oliveira
1Instituto do Coração do Hospital das Clínicas, FMUSP.
Insights
A ruptured left sinus of Valsalva caused a pseudoaneurysm, distorting the left coronary artery in a 44-year-old male. Surgical repair with a pericardium patch was successful, with no complications.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Imaging
Background:
- Aortic sinus of Valsalva aneurysms are rare congenital or acquired conditions.
- Rupture of the sinus of Valsalva can lead to pseudoaneurysm formation and coronary artery compromise.
- Mediastinal masses require thorough diagnostic investigation to determine etiology and guide management.
Observation:
- A calcified middle mediastinal mass was incidentally found on chest imaging.
- Cineangiography revealed a ruptured left sinus of Valsalva forming a pseudoaneurysm.
- The pseudoaneurysm significantly distorted the left coronary artery and its main branches.
Findings:
- Surgical repair involved closing the ruptured sinus of Valsalva orifice with a bovine pericardium patch.
- Organized thrombi within the subepicardium were removed during surgery.
- The patient experienced an uncomplicated postoperative recovery.
Implications:
- This case highlights the importance of prompt diagnosis and surgical intervention for sinus of Valsalva rupture.
- Successful surgical management can prevent life-threatening complications such as myocardial infarction or heart failure.
- Further research into the etiology of sinus of Valsalva rupture may improve preventative strategies.
Abstract:
A healthy 44 year-old male patient presented a calcified mass in the middle mediastinum on a chest film. During diagnostic investigation cineangiograms showed a rupture of the left sinus of Valsalva forming a large pseudoaneurysm that produced important distortion of the left coronary artery and it's main branches. The patient was submitted to surgical repair through the closure of the orifice of the ruptured left sinus of Valsalva with a bovine pericardium patch. The subepicardium was filled with organized thrombi which were removed. He was discharged from the hospital after uncomplicated postoperative course. Pathological examination of the aortic fragment did not yield the etiology of the rupture.