Tuesday, April 14, 2015

Is It Really Ruptured Sinus Of Valsava? The Crucial Role Of Comprehensive Transesophageal Echocardiography In Clinical Decision-Making

Case History:

A 49 years old NYHA grade III male patient presented with orthopnea and grade III dyspnea. His electrocardiogram showed left axis deviation and evidence of left ventricular hypertrophy. The chest X-ray except for cardiomegaly with left ventricular apex was inconclusive. Upon TTE patient was diagnosed with RSOVA draining into left ventricle. Cardiac catheterization and angiography further showed- normal coronaries, right coronary cusp (RCC) aneurysm with rupture into left ventricle causing severe regurgitation [Figure 1], normal left ventricle function, absence of any VSD, no gradient across left ventricle and aorta and Qp/Qs=1. Patient was scheduled for RSOVA repair with aortic valve repair / replacement.

POINTS TO PONDER:

  • TEE should be considered routine monitoring in Sinus of Valsalva aneurysm cases.
  • Transesophageal echocardiography is more useful when compared to transthoracic echocardiography in detecting: a) the fistula; b) the sinus involved; c) the right chamber affected; d) congenital aneurysms morphology and size; e) aneurysm prolapse through a ventricular septal defect, f) the identification of other cardiac congenital or acquired anomalies. (Rev Esp Cardiol 2002;55(1):29-36)
  • TTE can miss diagnosis of RSOV in about 10% cases. (International Journal of Cardiology ; 2014, 173:Pages 33–9)
  • Anatomical details available on TEE should be used to improvise on the surgical plans and strategies.

 

Read Full Article at:  http://www.annals.in/article.asp?issn=0971-9784;year=2015;volume=18;issue=2;spage=221;epage=224;aulast=Jain

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