Right Valsalva sinus aneurysm ruptured into the right cavities

Abstract

Purpose and Objectives: VSA is a rare heart disease (1/2000 cases), discovered fortuitously, if unbroken aneurysms or with symptoms triggered by factors such as exercise, trauma, catheterization, folded on a preexisting condition, for example endocarditis, as happen in the ruptured cases. Material and methods: We reported 2 cases with VSA complicated by rupture into the right cavities and severe heart failure. Case 1: Male patient, 55 years, with minimal effort dyspnea, dyspnea with orthopnea, fatigue and edema of the legs, symptoms began with two months before admission, suddenly after a physical effort. Case 2: Male patient, 42 years with dyspnea at rest, paroxysmal nocturnal dyspnea and extreme fatigue, myopericarditis and pleurisy history. Echocardiography was the one which diagnosed in both cases: In the first case, the right Valsalva sinus giant dilation with perforation 5-6 mm with RV communication in the RVOT and left right gradient of 68 mmHg, severe pulmonary hypertension confirmed by catheterization -PAP 95/47 / 58 mmHg, pulmonary circulation being charged 4 times. In the second case, it revealed the presence of an abscess of VSA ruptured into RA, with left-right shunt. Surgical correction was performed in both cases by aneurysm resection and suture of the defect, the first case adding mechanical prosthetic aortic caused by right coronary cusp prolapse, calcified and retracted. Results: Postoperative evolution was favorable in both cases, the progressive withdrawal of inotropic support in the first case, the patients were discharged at 14 and 8 days after surgery. Conclusions: Standard surgery mainly consists in aneurysm resection and suture defect processes, which could be easier in RA and RV involvement, but with a much more noisy symptoms in atrial segment.