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A case report: a rare case of severe aortic incompetence.
Eur Heart J Case Rep. 2020 Jun; 4(3):1-5.EH

Abstract

Background

Aneurysms of the sinus of Valsalva (SOV) are thin-walled outpouchings most commonly involving the right or non-coronary sinuses. Because they are asymptomatic, they are rarely discovered before they rupture and form an aorto-cardiac fistula. We present a rare case of unruptured aneurysm of the right coronary SOV burrowing into the interventricular septum with severe aortic incompetence and left ventricular dysfunction. To our knowledge, burrowing of the SOV aneurysm (SVA) into the interventricular septum and its large sac-like appearance has never been described using three dimensional (3D) echocardiography before.

Case summary

A 37-year-old man presented to the cardiology outpatient department with complaints of dyspnoea and palpitations (New York Heart Association Class II-III) for the last 6 months. He was evaluated with transthoracic echocardiography which showed a large mobile sac-like structure with irregular borders bulging and prolapsing into the left ventricular cavity with each cardiac cycle along with severe aortic incompetence. On transoesophageal echocardiogram, the right coronary cusp showed malcoaptation with deformed aortic sinus causing severe aortic incompetence. Cardiac computed tomography showed sparing of right coronary artery at the origin. A diagnosis of SVA was made. The patient underwent aortic valve replacement along with partial resection of the aneurysm. The patient had an uneventful postoperative course. Follow-up echocardiography after 4 weeks showed well-seated aortic valve prosthesis with residual SVA. The ejection fraction decreased from 46-48% to 36-38%.

Discussion

Comprehensive multimodality imaging can be used for management strategy of SVA.

Authors+Show Affiliations

Hero DMC (Dayanand Medical College) Heart Institute, Civil Lines, DMC Road, Tagore Nagar, Ludhiana, Punjab 141001, India.Hero DMC (Dayanand Medical College) Heart Institute, Civil Lines, DMC Road, Tagore Nagar, Ludhiana, Punjab 141001, India.Hero DMC (Dayanand Medical College) Heart Institute, Civil Lines, DMC Road, Tagore Nagar, Ludhiana, Punjab 141001, India.Hero DMC (Dayanand Medical College) Heart Institute, Civil Lines, DMC Road, Tagore Nagar, Ludhiana, Punjab 141001, India.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32617459

Citation

Sondh, Mandeep Singh, et al. "A Case Report: a Rare Case of Severe Aortic Incompetence." European Heart Journal. Case Reports, vol. 4, no. 3, 2020, pp. 1-5.
Sondh MS, Tandon R, Gupta R, et al. A case report: a rare case of severe aortic incompetence. Eur Heart J Case Rep. 2020;4(3):1-5.
Sondh, M. S., Tandon, R., Gupta, R., & Wander, G. S. (2020). A case report: a rare case of severe aortic incompetence. European Heart Journal. Case Reports, 4(3), 1-5. https://doi.org/10.1093/ehjcr/ytaa107
Sondh MS, et al. A Case Report: a Rare Case of Severe Aortic Incompetence. Eur Heart J Case Rep. 2020;4(3):1-5. PubMed PMID: 32617459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A case report: a rare case of severe aortic incompetence. AU - Sondh,Mandeep Singh, AU - Tandon,Rohit, AU - Gupta,Rajiv, AU - Wander,Gurpreet Singh, Y1 - 2020/05/26/ PY - 2019/08/13/received PY - 2019/10/17/revised PY - 2020/04/16/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Aortic regurgitation KW - Case report KW - Left ventricular dysfunction KW - Sinus of Valsalva aneurysm KW - Three dimensional (3D) echocardiography SP - 1 EP - 5 JF - European heart journal. Case reports JO - Eur Heart J Case Rep VL - 4 IS - 3 N2 - Background: Aneurysms of the sinus of Valsalva (SOV) are thin-walled outpouchings most commonly involving the right or non-coronary sinuses. Because they are asymptomatic, they are rarely discovered before they rupture and form an aorto-cardiac fistula. We present a rare case of unruptured aneurysm of the right coronary SOV burrowing into the interventricular septum with severe aortic incompetence and left ventricular dysfunction. To our knowledge, burrowing of the SOV aneurysm (SVA) into the interventricular septum and its large sac-like appearance has never been described using three dimensional (3D) echocardiography before. Case summary: A 37-year-old man presented to the cardiology outpatient department with complaints of dyspnoea and palpitations (New York Heart Association Class II-III) for the last 6 months. He was evaluated with transthoracic echocardiography which showed a large mobile sac-like structure with irregular borders bulging and prolapsing into the left ventricular cavity with each cardiac cycle along with severe aortic incompetence. On transoesophageal echocardiogram, the right coronary cusp showed malcoaptation with deformed aortic sinus causing severe aortic incompetence. Cardiac computed tomography showed sparing of right coronary artery at the origin. A diagnosis of SVA was made. The patient underwent aortic valve replacement along with partial resection of the aneurysm. The patient had an uneventful postoperative course. Follow-up echocardiography after 4 weeks showed well-seated aortic valve prosthesis with residual SVA. The ejection fraction decreased from 46-48% to 36-38%. Discussion: Comprehensive multimodality imaging can be used for management strategy of SVA. SN - 2514-2119 UR - https://www.unboundmedicine.com/medline/citation/32617459/A_case_report:_a_rare_case_of_severe_aortic_incompetence DB - PRIME DP - Unbound Medicine ER -
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