J Cardiovasc Ultrasound.  2015 Jun;23(2):113-117. 10.4250/jcu.2015.23.2.113.

A Case of Perimembranous Ventricular Septal Defect Associated with Sinus of Valsalva Aneurysm Mimicking Membranous Septal Aneurysm

• Kim HR
• Kim SJ
• Lim KH
• Kim JM
• Lee JH
• Kim YG
• Jung JP
• Lee SG

• KMID: 1806922
• DOI: http://doi.org/10.4250/jcu.2015.23.2.113

Abstract

Sinus of Valsalva aneurysms are rare. Sinus of Valsalva aneurysms are frequently associated with ventricular septal defect (VSD) and aortic regurgitation. They often remain asymptomatic until abruptly presenting with acute chest pain and heart failure secondary to rupture. Here, we describe a case of 20-year-old man who presented with chest pain with a history of VSD. Initial work-up concluded that the patient had VSD associated membranous septal aneurysm. Four years later, the patient presented with symptoms of heart failure. Work-up showed that the ruptured sinus of Valsalva aneurysm was the cause of symptoms. Due to its close proximity to the aortic annulus, sinus of Valsalva aneurysm should be differentiated from membranous septal aneurysm.

Keyword

Sinus of Valsalva aneurysm; Ventricular septal defect; Membranous septal aneurysm; Heart failure

MeSH Terms

Aneurysm*
Aortic Valve Insufficiency
Chest Pain
Heart Failure
Heart Septal Defects, Ventricular*
Humans
Rupture
Sinus of Valsalva*
Young Adult

Figure

• 

  Fig. 1 Initial transthoracic echocardiography. At parasternal short axis view, perimembranous ventricular septal defect (star) was detected with 2 dimensional and color Doppler echocardiography. Focal aneurysmal dilatation (arrowheads) was noted around the defect.

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  Fig. 2 Transthoracic echocardiography performed at the emergency room. A: At parasternal long axis view, 2-dimensional imaging showed the "windsock" appearance dilatation of right sinus of Valsalva (star) and its tip was ruptured. B: Color Doppler imaging showed diastolic jet flow through the ruptured right sinus of Valsalva aneurysm from the aortic root to the right ventricle. C: At parasternal short axis view, 2-dimensional and color Doppler imaging showed the RSVA (star) and VSD (arrowhead). D: At apical 5 chamber view, continuous wave Doppler showed systolic jet from VSD and diastolic jet from RSVA clearly. AV: aortic valve, LA: left atrium, LV: left ventricle, RV: right ventricle, RSVA: ruptured sinus of Valsalva aneurysm, VSD: ventricular septal defect.

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  Fig. 3 Photographs of surgical repair. A: After aortotomy, there was small defect at the tip of sinus of Valsalva aneurysm (8 mm sized, arrowheads). B: After right ventriculotomy, probe indicated the perimembranous ventricular septal defect (1 cm sized, star).

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  Fig. 4 Comparative images between sinus of Valsalva aneurysm and membranous septal aneurysm. A: Current case of sinus of Valsalva aneurysm at apical 5 chamber view showed aneurysmal dilatation (star) above the aortic annulus. B: A case of membranous septal aneurysm at apical 4 chamber view showed aneurysmal dilatation (star) below the aortic annulus. Ao: aorta, LA: left atrium, LV: left ventricle, RA: right atrium.

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