Ann Thorac Surg 2009;87:1619. doi:10.1016/j.athoracsur.2008.08.044
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Unruptured Sinus of Valsalva Aneurysm Suspected to Be a Cardiac Tumor
Shigeru Sasaki, MD, PhD,
Miki Asano, MD, PhD,
Keiko Fukuda, MD,
Kenji Nishimura, MD,
Akihiro Mizuno, MD,
Norikazu Nomura, MD, PhD,
Akira Mishima, MD, PhD*
Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
* Address correspondence to Dr Mishima, Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan (Email: mishima{at}med.nagoya-cu.ac.jp).
A 56-year-old man was referred to our hospital due to multiple paroxysmal ventricular contractions. During clinical examination an intracardiac mass in the right atrium attached to the interatrial septum was demonstrated by an enhanced computed tomographic scan (Fig 1,
arrow) and magnetic resonance imaging (Fig 2,
arrow) in which no pulsatile flow was observed. No other systemic inflammation or valvular lesions were observed. An intracardiac tumor, which was possibly a malignancy, was initially suspected.
The operative findings revealed that the solid mass (30 x 32 x 36 mm) was attached to the right atrial wall adjacent to the commissure of the anterior and septal leaflet of the tricuspid valve. However, the mass was easily detached from the right atrial wall, and a defect hole appeared. The dimensions of the hole were 10 x 6 mm, which communicated with the noncoronary sinus, slightly toward the right of the center of the sinus of Valsalva. The aortic valve and annulus were intact, and no ventricular septal defect was present. The surface of the mass was severely calcified and thickened, and a huge solid thrombus, which appeared to be a tumor, occupied the interior. It was finally confirmed that the protrusion was not a tumor but a nonruptured aneurysm originating from the noncoronary sinus of Valsalva that protruded into the right atrium. Furthermore, a mild annular deformity of the tricuspid valve was observed because of the encroachment of the aneurysm. The orifice of the aneurysm was closed with a prosthetic patch, and the tricuspid valve was repaired. The patient's postoperative course was uneventful, and there has been no adverse event to date on follow-up at 1 year. Pathologic specimens revealed that the aneurysmal sac was filled with a highly laminated and calcified agglutinative thrombus, and the surface of the aneurysm contained only a layer of elastic fibers (Fig 3).
In this case, it was difficult to make the diagnosis prior to the operation due to the unique thrombus present in the aneurysm.
