Ruptured aneurysms of the aortic sinus of Valsalva

Abstract

Aneurysms of the aortic sinus of Valsalva (ASV) are uncommon. This study described 8 cases of ruptured aneurysms of the congenital variety observed over a 10 yr period in Singapore. Although ASV is classically diagnosed at the time of rupture, only 1 patient in this series presented with acute chest pain and dyspnea. All 8 patients had continuous murmurs. The clinical diagnosis was confirmed by cardiac catheterization and angiography in 8 patients and by thoracotomy in 6. In 6 patients, the aneurysm had ruptured into the right ventricle and in 2 into the right atrium. In the 5 patients where the site of the aneurysm could definitely be determined, 4 arose from the right coronary and 1 from the noncoronary sinus. This marked preponderence of right coronary sinus over noncoronary sinus aneurysm in Singapore is more in accordance with the Japanese than with the Western experience. A systolic gradient due to the aneurysm pressing on the right ventricular outflow tract was established in 4 patients during cardiac catheterization and angiography and confirmed in 3 patients at thoracotomy. 6 Patients underwent operation and were alive and well from 7 mth to 3 yr later.