2020 Volume 84 Issue 12 Pages 2324-
A 49-year-old woman previously diagnosed with a small ventricular septal defect (VSD) visited hospital complaining of advanced shortness of breath on exertion.
She had a remarkable systolic heart murmur. Transthoracic echocardiography (TTE) showed obstruction of the right ventricular outflow tract (RVOT) by an extended sinus of Valsalva aneurysm (SVA) of 36.4 mm in diameter, through the subpulmonary VSD (Figure A–C, Supplementary Movie). The maximum flow velocity in the RVOT was 3.95 m/s, and there was no significant aortic valve regurgitation. Enhanced cardiac computed tomography showed that the protruding right coronary cusp (RCC) obstructed the RVOT (Figure D,E).
(A,B) Preoperative transthoracic echocardiography (TTE) in the systolic and diastolic phases. (C,G) Pre- and postoperative diameters of the sinus of Valsalva. (D,E) Contrast-enhanced computed tomography findings. (F) The protruding RCC in the subvalvular right ventricular outflow tract. PV, pulmonary valve; RCC, right coronary cusp.
Administration of β-blockers temporarily relieved her breathlessness, but the symptom recurred. We performed RVOT repair to remove the obstruction and a VSD patch closure, without repairing the SVA. Intraoperative findings showed the RCC protruding just below the pulmonary valve (Figure F). After the operation, her symptoms subsided and the sinus of Valsalva was restored to its original diameter of 28 mm (Figure G).
Definitive treatment for SVA has not yet been established. Surgical intervention may be required for symptomatic RVOT obstruction due to an unruptured SVA;1 however, repair of the SVA itself may be unnecessary unless there is distortion of the aortic valve.
I.K. is a member of Circulation Journal’ Editorial Team. The authors declare no conflicts of interest.
Supplementary Movie. Preoperative transthoracic echocardiography (TTE) findings.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-20-0554
