Young patient with a rare cause of heart failure

Introduction: The three Valsalva sinuses are hollow stru ctures named after the corresponding aortic valve cusps. Valsalva sinus aneurysms are relatively rare, may be congenital or acquired, the most common being congenital, most often affecting the right coronary sinus. It may be secondary to bacterial endocarditis, syphilis, atherosclerosis, aortic dissection, Marfan syndrome or as a result of chest trauma. The purpose of this paper is to present the case of a young patient with a rare congenital anomaly. Methods: Patient, aged 33 years, smoker, with asthma under treatment, left posttraumatic pneumothorax with repeted pleurodesis, solved by surgery, is hospitalized for dyspnea at rest, dry cough accentuated in clino statism and cyanosis, symptoms worsened two months before hospitalisation, with onset of two years ago. On clinical exam the patient’s general status is mediocre, left latero-thoracic postsurgical scar, mixt cyanosis, rest dyspnea, dry cought, normal pulmonary aus cultation, S O2 = 97%, anterior chest pain, turgid jugular veins, tachycardia, normal blood pressure, left parasternal continuous murmur of high intensity, accentuated by Valsalva maneuver, loud S 2 palpable in pulmonary area, systolic tricuspidian murmur, no edemas, hepatomegaly and hepato-jugular reflux. Results: ECG: sinusal rythm, 120 bpm, RBB. Laboratory: myocardial and hepatic increased enzymes, increased creatinine. Ecocardiography: LVEF=60%, dilated right cavities and pulmonary artery, moderate pulmonary and tricuspidian regurgitation, noncoronary Valsalva sinus aneurysm ruptured into the right atrium with left to right shunt hemodynamic signifi cant, mild pericardites, aft er Valsalva maneuver air bubbles are visible into the right cavities with dissapearance aft er 10 minutes of left lateral decubitus. Contrast echocardiography: no comunication between right and left cavities. He receives antialdosteronic and loop diuretic, UFH, beta blocker, bronchodilator. Patient is transferred for the correction of the deffect to the cardiac surgery ward with good evolution and hemodynamic compensation. Conclusions: Most of the Valsalva sinus aneurysms are congenital and associated with structural anomalies like VSD, aortic bicuspidia, aortic regurgitation. Cystic necrosis of the media and anulo-aortic ectasia might be the cause of the aneurysm. The absence of the media at the junction between sinus and aortic valvular ring favors the development of a true aneurysm at this level.The aneurysm can be open in a cardiac chamber, usually in the right atrium or the right ventricle near the membranous septum. Ruptured aneurysm, which is asymptomatic, in a right heart chamber, allows a cardiac left to right shunt followed by heart failure symptoms. Early diagnosis and closure of the defect, before arterial pulmonary hypertension appearance, is associated with a good long time prognostic.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)