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Right Sinus of Valsalva Aneurysm Causing Right Ventricular Tract Obstruction
Thilak Chellasamy R, Ibrahim M, Idhrees M, Ravi K, Arumugam A, Velayudhan B. Right Sinus of Valsalva Aneurysm Causing Right Ventricular Tract Obstruction. January 2025. doi:10.25373/ctsnet.28297250
Introduction
This is the case of a 54-year-old woman who presented with progressive breathlessness. Diagnostic workup revealed an unruptured sinus of Valsalva aneurysm (SVA) originating from the right coronary sinus, causing significant right ventricular outflow tract obstruction (RVOTO). The aneurysm was associated with thrombus formation and calcification at the aortic commissures and the ostium of the right coronary artery (RCA).
Methods
A midline sternotomy was performed under cardiopulmonary bypass with ascending aorta and bicaval cannulation. Upon exploration, the aneurysm from the right sinus of Valsalva was found to be filled with thrombus, compressing the RVOT. Due to extensive calcification at the commissures and the aortic root, it was decided to perform a Bentall procedure for definitive management. The thrombus was removed, and the aortic root was replaced with a valved conduit.
Inspection revealed that the ostium of the RCA was severely calcified, precluding direct reimplantation. Therefore, the RCA ostium was oversewn, and coronary revascularization was achieved with a saphenous vein graft (SVG) to the proximal RCA.
Results
Preoperative imaging, including echocardiography and computed tomography, accurately delineated the aneurysm’s size, extent, and compressive effects. The procedure was successful in addressing the RVOTO. The patient’s recovery was uneventful, and she was discharged in stable condition. Follow-up echocardiography showed no residual outflow tract obstruction, and the grafted RCA demonstrated good flow.
Conclusion
Sinus of Valsalva aneurysms, though rare, can lead to life-threatening complications such as RVOTO (1). This case demonstrates that surgical repair using a Bentall procedure is a safe and effective strategy in cases with complex anatomy and calcification. Early recognition and individualized surgical planning are essential for optimizing outcomes.
References
- Thankachen R, Gnanamuthu R, Doshi H, Shukla V, Korula RJ. Unruptured aneurysm of the sinus of Valsalva presenting with right ventricular outflow obstruction. Tex Heart Inst J. 2003;30(2):152-154.
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