|
1
|
Ayati A, Toofaninejad N, Hosseinsabet A, Mohammadi F, Hosseini K. Transcatheter closure of a ruptured sinus of valsalva: a systematic review of the literature. Front Cardiovasc Med 2023; 10:1227761. [PMID: 37727309 PMCID: PMC10505828 DOI: 10.3389/fcvm.2023.1227761] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023] Open
Abstract
Background Ruptured sinus of Valsalva (RSOV) is a rare pathology, and current data regarding its symptoms, anatomy, associated pathologies, and appropriate therapeutic approaches are scarce. Transcatheter closure (TCC) has been performed in multiple cases; however, the information on its success rate and complications is limited. Methods Two independent reviewers performed an advanced search based on inclusion criteria on Scopus, PubMed, and Embase from January 1985 through July 2022. The main search terms were "Sinus of Valsalva", "Rupture/Aneurysm", and "Transcatheter/Catheter/Device". Results Totally, 1,017 relevant articles from the 3 databases were retrieved. After the final review and appraisal, 94 articles describing 407 patients who underwent the TCC of RSOV were included. Males comprised 65% of the studied patients, and the average age was 34.5 years. The total success rate of TCC was 95.6%. Forty-nine patients (12%) developed complications, the most significant of which were sustained residual shunts in 7 patients (1.7%), substantial new onset or progression of aortic insufficiency in 6 (1.5%), and RSOV recurrence in 6 (1.5%). Post-interventional mortality was reported in only 2 patients (0.5%). Conclusions The present study is the first systematic review of available data regarding the TCC of RSOV principally comprising case series and case reports. Although TCC seems a good option, precise patient selection is mandatory.
Collapse
|
|
2
|
Liu XP, Wang HJ, Gao JL, Ma GL, Xu XY, Ji LN, He RX, Qi BYE, Wang LC, Li CQ, Zhang YJ, Feng YB. Secondary coronary artery ostial lesions: Three case reports. World J Clin Cases 2022; 10:7045-7053. [PMID: 36051134 PMCID: PMC9297412 DOI: 10.12998/wjcc.v10.i20.7045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/24/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atherosclerosis is one of the main causes of coronary artery ostial lesions seen clinically. Secondary coronary artery ostial lesions are rare, and cases reported previously were associated with syphilitic vasculitis and aortic dissection. Here, we report three rare cases of secondary coronary ostial lesions. Due to their rareness, these lesions can easily be neglected, which may lead to misdiagnosis and missed diagnosis.
CASE SUMMARY We present three patients with acute myocardial infarction and unstable angina caused by secondary coronary artery ostial lesions. In Case 1, coronary angiography (CAG) revealed 90% stenosis of the left main coronary ostium. Chest contrast computed tomography (CT) suggested thymic carcinoma invading the left main coronary ostium. Coronary artery bypass grafting and tumor resection were performed. In Case 2, echocardiography revealed a sinus of Valsalva aneurysm (SVA)-like dilatation. CAG showed a right coronary sinus giant aneurysm and complete obstruction of the right coronary artery (RCA) ostium. Aortic contrast CT confirmed these findings. The Bentall procedure was performed. In Case 3, CT CAG identified an anomalous origin of the right coronary artery (AORCA) from the left sinus of Valsalva coursing between the aorta and pulmonary trunk, causing severe RCA ostium stenosis by compression. Surgical correction of the AORCA was performed.
CONCLUSION The cases reported here suggest that we should consider other causes of coronary ostial lesions other than atherosclerosis.
Collapse
Affiliation(s)
- Xiao-Ping Liu
- Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Hai-Jun Wang
- Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Jin-Liang Gao
- Laboratory of Molecular Medicine, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Guo-Li Ma
- Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Xin-Yun Xu
- Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Li-Na Ji
- Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Rui-Xia He
- Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Ba-Ya-Er Qi
- Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Li-Cheng Wang
- Department of Radiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Chang-Qing Li
- Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Ya-Jiang Zhang
- Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| | - Yu-Bao Feng
- Department of Cardiology, Ordos Clinical College of Inner Mongolia Medical University, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China
| |
Collapse
|
|
3
|
Yang K, Luo X, Tang Y, Hu H, Sun H. Comparison of clinical results between percutaneous closure and surgical repair of ruptured sinus of Valsalva aneurysm. Catheter Cardiovasc Interv 2020; 97:E354-E361. [PMID: 32865329 DOI: 10.1002/ccd.29216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study was conducted to investigate whether percutaneous closure of ruptured sinus of Valsalva aneurysm (SVA) is as safe and effective as surgery repair. BACKGROUND Percutaneous closure of ruptured SVA has been becoming an alternative to the traditional surgical repair recently. The reports regarding direct comparison of these two treatment options are scarce. METHODS The medical records from the institutional database were retrospectively analyzed. A total of 134 patients were reviewed, including 26 patients undergoing percutaneous closure and 108 patients being treated surgically. To reduce the potential bias, 32 patients from Surgical Repair group were selected by propensity score matching. RESULTS All the ruptured SVAs were successfully closed in each group. No severe procedure-related complications were found in the perioperative period. After matching, there were no significant differences in the baseline clinical characteristics. The median postoperative hospital stays of Matched group were significantly longer than that of Percutaneous Closure group (7 days vs. 1 day, p < .001). Aortic regurgitation, residual shunt and recurrence of SVAs were common complications in both Percutaneous Closure group and Surgical Repair group. CONCLUSIONS The appropriately selected patients with ruptured SVA could be treated by percutaneous closure with an acceptable risk of short-term complications. Though surgical repair remains the main treatment option for ruptured SVAs, percutaneous closure could be considered in patients with a small-size rupture and no associated cardiac abnormalities.
Collapse
Affiliation(s)
- Kai Yang
- Center of Structural Heart Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaokang Luo
- Center of Cardiac Surgery for Adults, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Tang
- Center of Cardiac Surgery for Adults, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haibo Hu
- Center of Structural Heart Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hansong Sun
- Center of Cardiac Surgery for Adults, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
|
4
|
|
|
5
|
Sood N, Ehrlich P, Meerbach D, Kindermann M. Percutaneous closure of an iatrogenic aorto-right atrial fistula of the sinus of Valsalva through total arm approach: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32128484 PMCID: PMC7047051 DOI: 10.1093/ehjcr/ytz231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/23/2019] [Accepted: 12/04/2019] [Indexed: 11/14/2022]
Abstract
Background Creation of an iatrogenic aorto-right atrial fistula is a rare but clinically relevant complication of cardiac surgery. Transfemoral percutaneous closure is an attractive alternative to surgical repair, but there are no reports about transcatheter repair using a complete arm access. Case summary We present the case of a 44-year-old woman with heart failure (NewYork Heart Association Class III) due to a longstanding iatrogenic fistula from the non-coronary aortic cusp to the right atrium (RA) with aorta to RA shunting and severe tricuspid regurgitation (TR) caused by mitral valve replacement 15 years ago. The patient was successfully treated by percutaneous closure with an Amplatzer Vascular Plug II using complete brachial access. Following the procedure right heart chambers and TR decreased and symptoms resolved. Discussion To the best of our knowledge this is the first report of percutaneous repair of an aorto-right atrial fistula using total arm accesses (radial artery and basilic vein). In appropriately selected patients, this approach is an attractive alternative to femoral access.
Collapse
Affiliation(s)
- Nitin Sood
- Department of Cardiology and Angiology, CaritasKlinikum, Saarbruecken, Academic Teaching Hospital of the Saarland University Faculty of Medicine, Rheinstrasse 2, 66113 Saarbruecken, Germany
| | - Peter Ehrlich
- Department of Cardiology and Angiology, CaritasKlinikum, Saarbruecken, Academic Teaching Hospital of the Saarland University Faculty of Medicine, Rheinstrasse 2, 66113 Saarbruecken, Germany
| | - Dorothee Meerbach
- Department of Cardiology and Angiology, CaritasKlinikum, Saarbruecken, Academic Teaching Hospital of the Saarland University Faculty of Medicine, Rheinstrasse 2, 66113 Saarbruecken, Germany
| | - Michael Kindermann
- Department of Cardiology and Angiology, CaritasKlinikum, Saarbruecken, Academic Teaching Hospital of the Saarland University Faculty of Medicine, Rheinstrasse 2, 66113 Saarbruecken, Germany
| |
Collapse
|
|
6
|
Xu B, Kocyigit D, Betancor J, Tan C, Rodriguez ER, Schoenhagen P, Flamm SD, Rodriguez LL, Svensson LG, Griffin BP. Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review. J Am Soc Echocardiogr 2020; 33:295-312. [PMID: 32143779 DOI: 10.1016/j.echo.2019.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/18/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Cardiovascular imaging has an important role in the assessment and management of aortic root and thoracic aorta ectasia and aneurysms. Sinus of Valsalva aneurysms are rare entities. Unique complications associated with sinus of Valsalva aneurysms make them different from traditional aortic root aneurysms. Established guidelines on the diagnosis and management of sinus of Valsalva aneurysms are lacking. This article reviews the applications of multimodality cardiovascular imaging (echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging) for the dedicated assessment and imaging-guided management of sinus of Valsalva aneurysms.
Collapse
Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Carmela Tan
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - E Rene Rodriguez
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
|
7
|
Tang L, Zhou SH, Fang ZF. Transcatheter Closure of Ruptured Sinus of Valsalva Aneurysm with Double-Disc Perimembranous VSD Occluder in Man with Mechanical Aortic Valve. Tex Heart Inst J 2019; 46:211-214. [PMID: 31708706 DOI: 10.14503/thij-17-6215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sinus of Valsalva aneurysm, a rare cardiac anomaly, can be life-threatening if it ruptures. Transcatheter closure has emerged as an effective alternative to surgical management; however, it has rarely been reported in patients with previous mechanical aortic valve replacements. We describe the case of a 45-year-old man who presented with a ruptured aneurysm of the noncoronary sinus of Valsalva 14 years after the implantation of a mechanical aortic valve. The ruptured aneurysm was closed by transcatheter means with use of a double-disc perimembranous ventricular septal defect occluder. The patient remained asymptomatic one year after the procedure. Our case suggests that transcatheter closure with use of this type of occluder is a viable method for successfully repairing ruptured sinus of Valsalva aneurysms in patients who have mechanical aortic valves.
Collapse
|
|
8
|
Vernemmen I, De Clercq D, Decloedt A, Schauvliege S, Taeymans Y, De Wolf D, van Loon G. Percutaneous transcatheter closure of an aorto-cardiac fistula in a six-year-old Warmblood mare with atrial fibrillation. J Vet Cardiol 2019; 24:78-84. [PMID: 31405558 DOI: 10.1016/j.jvc.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/21/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
This report describes a rare case of an aorto-cardiac fistula in a six-year-old French Warmblood mare presented with atrial fibrillation, decreased performance, ventral oedema, bounding arterial pulsation and pathological jugular venous pulse. A 2.7-cm-diameter fistula connected the right aortic sinus of Valsalva to the right atrium. Atrial fibrillation was likely due to volume overload of the right heart due to left-to-right shunting. The horse was treated by percutaneous transcatheter closure of the fistula delivered under general anaesthesia using a transarterial approach. The operation was initially successful, and clinical signs of congestive heart failure improved immediately. However, the device dislodged six days after procedure, and the general condition of the horse deteriorated quickly. A second closure attempt to deliver the occluder using a transvenous approach in the standing horse failed, and the horse was eventually euthanized. Procedural aspects and several possible risk factors for device dislodgement are discussed.
Collapse
Affiliation(s)
- I Vernemmen
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - D De Clercq
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - A Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - S Schauvliege
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - Y Taeymans
- Department of Pediatric Cardiology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium
| | - D De Wolf
- Department of Pediatric Cardiology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium
| | - G van Loon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| |
Collapse
|
|
9
|
Galeczka M, Glowacki J, Yashchuk N, Ditkivskyy I, Rojczyk D, Knop M, Smerdzinski S, Cherpak B, Szkutnik M, Bialkowski J, Fiszer R, Lazoryshynets V. Medium- and long-term follow-up of transcatheter closure of ruptured sinus of Valsalva aneurysm in Central Europe population. J Cardiol 2019; 74:381-387. [PMID: 31023567 DOI: 10.1016/j.jjcc.2019.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/07/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to evaluate medium- and long-term outcomes of transcatheter closure (TC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease. METHODS Retrospective analysis included 23 patients (14 males) aged 15-79 years (y; 39.9±18.5) selected for TC of RSVA between 2007 and 2017 in two tertiary centers in Poland and Ukraine. Fifteen patients were in New York Heart Association (NYHA) class III or IV before TC; 5 patients had acquired RSVA after previous cardiac surgery. We applied 22 duct, 3 muscular, and 1 atrial septal Amplatzer or Amplatzer-like occluders by the anterograde venous approach after arterio-venous loop creation in all but 1 patient. Mean follow-up conducted in outpatient clinic was 5.5±3.5 (1-11)y. RESULTS The procedure was successful in 19/23 patients (82.6%). Four procedures were abandoned and the device percutaneously retrieved due to coronary artery compression (1 patient), transient increase of aortic regurgitation (AR; 1 patients) or embolization (2 patients). New onset of significant AR was noted in one of the latter patients after device removal. NYHA class improved in all treated patients but 2, in whom it remained stable (p<0.05), with 10 patients in class I. Three patients needed percutaneous re-intervention during follow-up because of significant residual shunt in 1 and late recurrent RSVA in 2 patients. The follow-up of the remaining patients was uneventful. Neither erosion, embolization, new AR, nor death were observed. CONCLUSIONS The percutaneous closure of RSVA is a safe and effective method of treatment with good clinical outcome. However, although not described previously, recurrent shunts after TC of RSVA are possible and can be treated successfully with another transcatheter intervention.
Collapse
Affiliation(s)
- Michal Galeczka
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - Jan Glowacki
- Department of Radiology and Radiodiagnostics, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Nataliia Yashchuk
- Department of Interventional Cardiology for Congenital and Acquired Heart Disease, National Amosov Institute, Kyiv, Ukraine
| | - Igor Ditkivskyy
- Department of Cardiovascular Surgery, National Amosov Institute, Kyiv, Ukraine
| | - Dominika Rojczyk
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Mateusz Knop
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Sebastian Smerdzinski
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Bogdan Cherpak
- Department of Interventional Cardiology for Congenital and Acquired Heart Disease, National Amosov Institute, Kyiv, Ukraine
| | - Malgorzata Szkutnik
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Jacek Bialkowski
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Roland Fiszer
- Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Vasyl Lazoryshynets
- Department of Cardiovascular Surgery, National Amosov Institute, Kyiv, Ukraine
| |
Collapse
|
|
10
|
Wingo M, de Angelis P, Worku BM, Leonard JR, Khan FM, Hameed I, Lau C, Gaudino M, Girardi LN. Sinus of Valsalva aneurysm repairs: Operative technique and lessons learned. J Card Surg 2019; 34:400-403. [PMID: 30953447 DOI: 10.1111/jocs.14041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/15/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Sinus of Valsalva (SOV) aneurysms are rare and data on operative management are limited. They can cause right ventricular outflow tract or pulmonary artery compression, and rupture may be fatal. In this study, we describe our experience with the repair of 13 SOV aneurysms. METHODS All patients who underwent SOV aneurysm repair from May 2001 to December 2017 at our single tertiary referral center were reviewed retrospectively. RESULTS Thirteen patients (92% male) with a mean age of 60 years underwent repair of an SOV aneurysm; mean aneurysm diameter was 5.9 ± 0.8 cm and four patients (30.7%) presented with rupture into another cardiac chamber. Operative interventions included six Bentall procedures, five patch repairs (one with aortic valve replacement [AVR]), and two primary aneurysm closures both with concomitant AVR. There were no strokes, myocardial infarctions, re-explorations, or deaths in the postoperative period. After an average of 2.25 years, computed tomographic imaging in five patients demonstrated no aneurysm recurrence. CONCLUSIONS Surgery is a safe option for both ruptured and nonruptured SOV aneurysms. A variety of repair strategies may be used. Larger studies are needed.
Collapse
Affiliation(s)
- Matthew Wingo
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Paolo de Angelis
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Berhane M Worku
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Jeremy R Leonard
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Faiza M Khan
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| |
Collapse
|
|
11
|
Yang K, Wei MD, Geng WL, Hu HB, Xu ZY, Zhang GJ, Zhao SH. Safety and efficacy of percutaneous closure of ruptured sinus of Valsalva aneurysm. EUROINTERVENTION 2018; 14:e1288-e1294. [PMID: 30327286 DOI: 10.4244/eij-d-18-00294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to evaluate the safety and efficacy of percutaneous closure in patients with a ruptured sinus of Valsalva aneurysm (RSVA). METHODS AND RESULTS A total of 29 patients with RSVA were retrospectively enrolled in our study. All patients were successfully treated by percutaneous closure and had a complete closure at discharge; however, two patients had a trivial procedure-related aortic regurgitation (AR) after the procedure. On a mean follow-up of 29.7±23.8 months (range 1-83 months), the two procedure-related AR disappeared three months and two years after the procedure, respectively. Trivial residual shunt was found in one patient, sinus of Valsalva aneurysm ruptured again in one patient and trivial to moderate AR was found in two patients during the follow-up. CONCLUSIONS In appropriately selected patients with RSVA, percutaneous closure is an attractive alternative to surgery with high technical success and good short-term and midterm outcomes; however, long-term follow-up is mandatory.
Collapse
Affiliation(s)
- Kai Yang
- Centre of Structural Heart Disease, Fuwai Hospital and National Centre for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | |
Collapse
|
|
12
|
Cierre de ruptura del seno de Valsalva no coronariano con dispositivo de Amplatzer asociado a implante de válvula aórtica transcateterismo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
|
13
|
Marroush TS, Boshara AR, Botros B, Vendittelli P, Ahmed Z, Dawood L, Rosman HS. Rupture of sinus of Valsalva aneurysm: Two case reports and a concise review of the literature. Heart Lung 2018; 47:131-135. [DOI: 10.1016/j.hrtlng.2017.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
|
|
14
|
Gu X, Zhang Q, Sun H, Fei J, Zhang X, Kutryk MJ. Transcatheter Closure Versus Repeat Surgery for the Treatment of Postoperative Left-to-Right Shunts: A Single Center 15-Year Experience. Cardiol Res 2018; 8:286-292. [PMID: 29317971 PMCID: PMC5755660 DOI: 10.14740/cr629e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/05/2017] [Indexed: 11/28/2022] Open
Abstract
Background Repeat surgery and the percutaneous approach (transcatheter closure (TCC)) have been used for the management of postoperative left-to-right shunts. In this study, we described our 15 years of experience in treating postoperative left-to-right shunts with these two approaches. Methods From February 2002 to February 2017, 50 patients with residual left-to-right shunts, following cardiac surgery, were treated using TCC or repeat surgery. Clinical examination, standard 12-lead electrocardiography, chest X-ray, and a transthoracic echocardiogram were performed before hospital discharge and at all follow-ups. Results The closure rate was 100% in both groups and there was no procedure-related mortality. Patients with TCC had few complications. The procedure time and duration of hospital stay for TCC patients were 58.9 ± 27.7 min and 6.1 ± 0.8 days, respectively. Eleven out of 19 patients receiving reoperation suffered serious complications after surgery, e.g., bleeding and nosocomial infections. The operation time and duration of hospital stay for reoperation patients were 256.7 ± 60.5 min and 17.0 ± 4.0 days, respectively. No other serious complications were seen at all follow-up visits for both groups. Conclusions In conclusions, TCC is safe and effective for the management of postoperative left-to-right shunts, and is associated with few complications, which can be the favored closure strategy over repeat surgery for the management of postoperative left-to-right shunts.
Collapse
Affiliation(s)
- Xinghua Gu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Qiuwang Zhang
- Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Hourong Sun
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Jianchun Fei
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Xiquan Zhang
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Michael J Kutryk
- Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
|
15
|
Jin Y, Han XM, Wang HS, Wang ZW, Fang MH, Yu Y, Fang XX. Coexisting ventricular septal defect affects the features of ruptured sinus of Valsalva aneurysms. Saudi Med J 2017; 38:257-261. [PMID: 28251220 PMCID: PMC5387901 DOI: 10.15537/smj.2017.3.15842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the correlation exists between ventricular septal defect (VSD) and ruptured sinus of Valsalva aneurysm (RSVA). Methods: Between September 2003 and April 2014, 80 RSVA patients underwent surgical repair. These patients were retrospectively divided into two groups: the VSD group (38 cases) and the non-VSD group (42 cases). Results: Rupture points of SVA originated more frequently in the right coronary sinus (RCS) of patients in the VSD group than those in the non-VSD group (p=0.002). In the VSD group, more than 92.1% tended to rupture into the right ventricular outflow tract. The rupture points are diverse in the non-VSD group. A significant difference was found in rupture points of RSVA between the two groups (p<0.001). Patients in the VSD group presented with aortic valve disease more often than those in the non-VSD group (p<0.001). A total of 67 patients were repaired with a patch at the opening of RSVA; of those, all patients in VSD group and 29 patients in non-VSD group were repaired with a patch. Nine patients in non-VSD group received transcatheter closure of RSVA. Conclusion: The presence or absence of VSD affects the rupture points of SVA, aortic valve disease involved, and therapeutic schedule. Ruptured sinus of Valsalva aneurysm type should be clinically modified on the basis of presence or absence of VSD.
Collapse
Affiliation(s)
- Yan Jin
- Department of Cardiovascular Surgery, Military General Hospital of Shenyang PLA, Shanghai University of International Business and Economics, Shenyang, China. E-mail.
| | | | | | | | | | | | | |
Collapse
|
|
16
|
Mahimarangaiah J, Chandra S, Subramanian A, Srinivasa KH, Usha MK, Manjunath CN. Transcatheter closure of ruptured sinus of Valsalva: Different techniques and mid-term follow-up. Catheter Cardiovasc Interv 2015; 87:516-22. [PMID: 26255646 DOI: 10.1002/ccd.26107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 06/21/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The aim of the present study was to study the feasibility and approaches to device closure of ruptured sinus of Valsalva (RSOV). We have compared the advantages and disadvantages of different devices and techniques and discussed complications which might occur during or after the procedure. BACKGROUND There are only a few case series of transcatheter closure of RSOV, with most cases being traditionally referred for surgery. We have employed different devices used for treatment of congenital shunt lesions to achieve closure. Reasons for failure and need for surgical referral have also been analyzed. METHODS Transcatheter closure was attempted in a total of 25 patients of RSOV who presented to us over a period of 4 years. Different devices were deployed using antegrade and retrograde approaches. All patients have been on regular follow-up. RESULTS The procedural success rate was 84%. Two patients presenting in cardiogenic shock were effectively treated by device closure. There was one case of device embolization and two patients had residual leak. Three patients were referred for surgery. There was one case of device induced severe aortic regurgitation. Ventricular septal defect and RSOV were closed simultaneously in one patient. CONCLUSIONS Different approaches and devices may be used for transcatheter closure of RSOV. We prefer antegrade closure using duct occluders in most cases while muscular VSD occluders may be used in select situations. ADO II devices should hardly ever be used on their own for device closure of RSOV.
Collapse
Affiliation(s)
- Jayranganath Mahimarangaiah
- Departments of Pediatric Cardiology and Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Subash Chandra
- Department of Cardiology, Manipal Hospitals, Bangalore, Karnataka, India
| | - Anand Subramanian
- Departments of Pediatric Cardiology and Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - K H Srinivasa
- Departments of Pediatric Cardiology and Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - M K Usha
- Departments of Pediatric Cardiology and Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - C N Manjunath
- Departments of Pediatric Cardiology and Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| |
Collapse
|