Giant unruptured sinus of Valsalva aneurysm with complete heart block

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Case Reports

Background:

• Sinus of Valsalva aneurysms (SOVA) are rare, and giant unruptured SOVA can present as a cardiac emergency.
• Unruptured SOVA can compress adjacent cardiac structures, leading to severe complications without typical aneurysm rupture symptoms.

Purpose of the Study:

• To report a rare case of a giant unruptured sinus of Valsalva aneurysm presenting with complete heart block.
• To illustrate the diagnostic and therapeutic challenges and outcomes in such critical cases.

Main Methods:

• Emergency evaluation using transthoracic echocardiography, transesophageal echocardiography, and cardiac catheterization with temporary pacing.
• Surgical intervention involving repair of the sinus of Valsalva aneurysm and posterior mitral ring annuloplasty.

Main Results:

• The giant unruptured SOVA dissected into the interventricular septum, causing complete heart block, significant tricuspid and mitral regurgitation, and biventricular dysfunction.
• Post-surgical repair, complete heart block resolved to sinus rhythm by day 11.
• Tricuspid regurgitation improved to mild, with persistent mild aortic regurgitation on follow-up.

Conclusions:

• Giant unruptured sinus of Valsalva aneurysms can precipitate cardiac emergencies like complete heart block.
• Prompt surgical intervention is crucial for life-saving treatment.
• Complete heart block may show improvement post-operatively, with potential for residual valvular dysfunction.