Repair of Isolated Sinus of Valsalva Aneurysm Causing Right Ventricular Outflow Tract Obstruction

Purpose

This is the case of a 64-year-old male who presented with right-sided heart failure symptoms. The patient had a severely dilated right sub-coronary sinus of Valsalva aneurysm, causing right ventricular outflow tract obstruction.

Methods

The surgical technique involved midline sternotomy, cardiopulmonary bypass, and ascending aorta and bicaval cannulation. The defect was approached from the aortic root via transverse aortotomy, as well as through a right ventriculotomy through the outflow tract. The right ventricle was significantly enlarged on visual inspection. The right ventricular outflow tract (RVOT) obstruction was compressed by the aortic sinus aneurysm. The authors opened the ascending aorta and exposed the aortic valve. Inspection revealed a healthy tricuspid aortic valve with a large defect underneath the right coronary artery. The defect within the right sinus of Valsalva measured approximately 3-5 cm in diameter. Visualization of the aneurysm through a right atriotomy and tricuspid valve was not satisfactory. The aneurysm was resected through the sub-pulmonic RVOT incision, and was over-sewn using pledgeted 4-0 prolene sutures in a continuous fashion. The right ventricular outflow tract was enlarged with bovine pericardium. The aorta was inspected, and 5 cm circular bovine pericardial patch was used to close the sinus of Valsalva aneurysm in a sub-coronary manner using running 5-0 prolene.

Results

Appropriate CT angiography and cardiac MRI imaging were performed to assess the location of the aneurysm and cardiac function. It was a successful repair of a rare non-ruptured aneurysm of the right sinus of Valsalva (7.6 cm x 5.5 cm) with RVOT compression through patch repair of the sub-coronary sinus, resection of the aneurysm from the RVOT, and patch enlargement of the RVOT.

Conclusion

Sinus of Valsalva aneurysm may present with right-sided heart failure symptoms. Primary surgical repair is feasible with good short-term outcomes once the right ventricular pressure overload has been corrected.