Unruptured Aneurysm of Right Coronary Sinus of Valsalva With Cystic Mitral Valve Anjith Prakash, MBBS, Kumar Chidambaram, DNB, Sivakumar Pandian, MCh, Gomathy Jeeva, BSPA, and Rajan Sethuratnam, MCh
FEATURE ARTICLES
Departments of Cardiac Surgery and Cardiac Anesthesiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, Mogappair, Chennai, Tamil Nadu, India
Fig 1.
Fig 2.
A
58-year-old man with dyspnea on exertion was diagnosed with an unruptured right coronary sinus of Valsalva aneurysm and severe aortic regurgitation. Intraoperative transesophageal echocardiography confirmed the diagnosis and revealed a cystic posterior leaflet of mitral valve with no mitral regurgitation or stenosis (Fig 1). An oblique aortotomy showed a 2 2 cm aneurysm of the right coronary sinus of Valsalva along the septum with a 2-cm mouth below the right coronary ostium. There was organized thrombus inside the aneurysm but no significant outflow/right coronary artery obstruction (Fig 2). Subsequent inspection of the mitral valve revealed a cystic posterior leaflet (Fig 3). Intraoperative saline tests confirmed no mitral regurgitation. He underwent a successful repair of the sinus of Valsalva aneurysm using interrupted 4-0 polypropylene sutures, with a second layer of continuous suturing of the mouth of the aneurysm, and aortic valve replacement with a 21-mm CarpentierEdwards PERIMOUNT bioprosthetic valve (Edwards Lifesciences, Irvine, CA) using interrupted 2-0 polyester pledgeted sutures. Fig 3.
Address correspondence to Dr Prakash, Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr JJ Nagar, Mogappair, Chennai-600037, Tamil Nadu, India; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
Ann Thorac Surg 2015;99:338 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.08.082
FEATURE ARTICLES
Departments of Cardiac Surgery and Cardiac Anesthesiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, Mogappair, Chennai, Tamil Nadu, India
Fig 1.
Fig 2.
A
58-year-old man with dyspnea on exertion was diagnosed with an unruptured right coronary sinus of Valsalva aneurysm and severe aortic regurgitation. Intraoperative transesophageal echocardiography confirmed the diagnosis and revealed a cystic posterior leaflet of mitral valve with no mitral regurgitation or stenosis (Fig 1). An oblique aortotomy showed a 2 2 cm aneurysm of the right coronary sinus of Valsalva along the septum with a 2-cm mouth below the right coronary ostium. There was organized thrombus inside the aneurysm but no significant outflow/right coronary artery obstruction (Fig 2). Subsequent inspection of the mitral valve revealed a cystic posterior leaflet (Fig 3). Intraoperative saline tests confirmed no mitral regurgitation. He underwent a successful repair of the sinus of Valsalva aneurysm using interrupted 4-0 polypropylene sutures, with a second layer of continuous suturing of the mouth of the aneurysm, and aortic valve replacement with a 21-mm CarpentierEdwards PERIMOUNT bioprosthetic valve (Edwards Lifesciences, Irvine, CA) using interrupted 2-0 polyester pledgeted sutures. Fig 3.
Address correspondence to Dr Prakash, Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr JJ Nagar, Mogappair, Chennai-600037, Tamil Nadu, India; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
Ann Thorac Surg 2015;99:338 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.08.082
