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Resumen: Se describe la forma de presentación, el diagnóstico y la resolución quirúrgica de un caso poco frecuente de aneurisma de seno de Valsalva. Se presenta el caso de una paciente femenina de 64 años con antecedentes de dos cirugías, una por ductus arterioso a los 12 años y la otra por una ventana aortopulmonar a los 16 años. Se encontraba asintomática. En un control de ecocardiografía, se observa válvula aórtica trivalva, insuficiencia leve y dilatación aneurismática del seno de Valsalva izquierdo. Realizamos una angiotomografía, la cual informó de un gran aneurisma de 88,9 mm saliendo de la coronaria izquierda de dicho seno. El cateterismo mostró un aneurisma de seno de Valsalva izquierdo, sin lesiones angiográficas. Decidimos realizar una intervención quirúrgica con circulación extracorpórea (canulación aórtica, cava y seno coronario). La paciente presentaba un aneurisma de gran tamaño con hematoma en el seno de Valsalva sobre el ostium de la coronaria izquierda, se extrajo el hematoma y se observó tejido sanioso en vía de fistulizarse hacia la aurícula izquierda. Se realizó la técnica de Yacoub con preservación valvular y un reimplante coronario izquierdo, así como la exclusión del aneurisma. El ecocardiograma intraoperatorio mostró buena competencia valvular e insuficiencia leve. La mujer presentó buena evolución, por lo cual se le dio el alta al séptimo día. Fue un caso complejo debido a la patología en sí y por ser una reoperación cardiaca. Existen varias formas de resolución, todos los componentes del complejo de la raíz aórtica deben considerarse y la técnica debe adaptarse a cada paciente. Aunque el abordaje quirúrgico óptimo sigue siendo controvertido, la competencia a largo plazo de la válvula aórtica parece seguir siendo la principal preocupación de los aneurismas de seno de Valsalva. Abstract: We describe the diagnostic and surgical resolution of a rare case of Valsalva sinus aneurysm. Sixty four (64) year old female patient with history of two previous surgery, one due to ductus arteriosus at age of 12 and an aortopulmonary window at age 16. Echocardiography control shows a severe dilatation of the left Valsalva sinus in a trivalve aortic valve with trivial insufficiency. Angiotomography reported a large aneurysm of left Valsalva sinus (88.9 mm) with coronary left main involved. Coronariography showed the same as TC without angiographic coronary lesions. Heart team dessision was surgical resolution with extracorporeal circulation (aortic cannulation, cava and coronary sinus). Patient presented a large aneurysm with great amount of thrombus in the left Valsalva sinus. The hematoma and thrombus was removed. Yacoub technique was performed with valvular preservation and left coronary reimplantation and exclusion of aneurysm. The intraprocedure trans esofagic echocardiogram showed trivial aortic insufficiency. Patient was discharged at seven days after procedure. There are several techniques for this pathology resolution. All components of the aortic root complex must be considered, and the technique must be adapted to each specific case. Although the optimal surgical approach remains controversial, long-term competence of the aortic valve appears to remain the main concern of Valsalva sinus aneurysms surgical treatment.

International audience; Rupture of Valsalva sinus remains a very rare and deadly complication of Valsalva sinus aneurysm with a high mortality rate. We report here the case of a 47-year-old man who presented to the emergency department with acute exercise-induced dyspnea, chest pain, and fever. Transthoracic (TTE) and transesophageal echocardiography (TEE) highlighted a rupture of the right Valsalva sinus in the right atrium due to infective endocarditis. After stabilization of the patient, a successful surgical repair with double pericardial patches was performed.

© 2010 by the American Society of Echocardiography., Aneurysms of the sinuses of Valsalva are uncommon in clinical practice. Most are congenital, but secondary causes are also recognized. Congenital aneurysms of the left sinus of Valsalva are particularly rare. The authors report a fatal case in which a nonruptured aneurysm of the left sinus of Valsalva dissected into the interventricular septum and presented as heart failure. The concurrent presence of dilated cardiomyopathy and the mechanisms that may have led to it are discussed on the basis of the anatomic and histologic features found at autopsy.

We describe a giant unruptured acquired aneurysm of the noncoronary sinus of Valsalva, which was detected incidentally in a 30-year-old rugby player with clinical suspicion of dermatomyositis. Sixty-four-slice cardiac computed tomography showed a giant aneurysm (diameters: 91 x 78 x 100 mm) of noncoronary sinus of Valsalva compressing both atrial chambers. The patient underwent cardiac surgery according to the Tirone David technique based on the information provided by cardiac computed tomography.