Ruptured aneurysm of the left sinus Valsalva into the pericardium
P.A. Doevendans, G.G. Geskes, G. van Aarnhem, R. van Suylen
Recently, a 67-year-old female patient came to our attention after a collapse, due to cardiac tamponade caused by a ruptured sinus of Valsalva aneurysm (SVA) and intrapericardial bleeding. Despite surgical intervention the patient died before correction. (NethHeartJ2001;9:346-8.) Key words: cardiogenic shock, sinus of Valsalva aneurysm
Sinus ofValsalva aneurysms (SVA) are uncommon cardiac malformations. They are congenital in origin and present as thin-walled, saccular outpouchings. Most frequently they originate from the right coronary sinus, while the left sinus is only involved in a few cases.' At the initial diagnosis, a rupture is found in 5080% of the patients with an SVA.2'3 These ruptures cause an aortic right ventricular connection in the majority of cases but can also formn a fistula to the right atrium and left ventricle. Rupture into the pericardial space is not a common complication.4'5 This case report describes a patient with a rupture of a left coronary artery related SVA into the pericardial space. Correct, immediate diagnosis ofthis disorder can be lifesaving as surgical intervention can be performed with good long-term prognosis.
P.A. Doevendans. Department of Cardiology. G.G. Geskes. G. van Aamhem. Department of Cardiothoracic Surgery. R. van Suylen. Department of Pathology. University Hospital Maastricht, P0 Box 5800, 6202 AZ Maastricht. Address for correspondence: P.A.F.M. Doevendans. E-mail: [email protected]
Case report A 67-year-old female was admitted to our hospital after she collapsed at home during dish washing. She had no history of cardiovascular disease, recent trauma or infections. On admission a cyanotic patient was seen, with a blood pressure of 100/60 mmHg from the right, and a systolic pressure of 60 mmHg from the left arm. The pulse was regular at 110 beats per minute. Auscultation revealed normal heart sounds without murmurs. The central venous pressure was elevated. An ECG showed sinus rhythm with a frequency of 110 beats per minute and minimal STT segment abnormalities. The chest X-ray revealed a cor-thorax ratio of