Ann Thorac Surg 2002;74:2198
© 2002 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Sinus of valsalva aneurysm
Wilson Ko, MD*a,
Shailen Patel, MDa
a Department of Cardiothoracic Surgery, Cornell University Medical College, New York, New York, USA
* Address reprint requests to Dr Ko, Department of Cardiothoracic Surgery, New York Hospital of Queens, 56-45 Main St, Room WA-100, Flushing, NY 11355 USA
e-mail: jrweiner{at}med.cornell.edu
A 49-year-old man was in good health until the recent development of worsening exertional dyspnea. A transthoracic echocardiogram demonstrated a mobile mass in the right atrium, and a transesophageal echocardiogram revealed evidence of a sinus of Valsalva aneurysm arising from the noncoronary aortic sinus. The diagnosis was confirmed on left-sided cardiac catheterization. The aortogram showed the "wind-sock" appearance of the aneurysmal sac arising from the aortic sinus and contrast medium extruding from the sac into the right atrium (Fig 1).
No associated aortic incompetence or ventricular septal defect was seen on echocardiograms or at cardiac catheterization.
Standard cardiopulmonary bypass was used during repair. Because of the ruptured aneurysm, cardioplegiawas injected directly into the coronary ostia after the aortotomy. The opening to the aneurysm was easily identified in the noncoronary aortic sinus, and the aneurysmal sac was pulled through the opening into the aorta (Fig 2).
The aneurysm was amputated at the neck. The venous cannula could be seen through the residual opening, thus confirming the communication to the right atrium. The defect was then closed with a patch of autologous pericardium (Fig 3).
The suture line of the repair was near the hinge line of the aortic valve leaflet. Therefore, a primary repair was thought to have a risk of distorting the valve mechanism and leading to incompetence. The intraoperative transesophageal echocardiogram demonstrated no aortic incompetence and no leaks through the patch repair. The recovery period was uneventful, and the patient is asymptomatic 1 year after operation.
