Re-rupture of calcified sinus of valsalva aneurysm 34 years after primary surgical repair

Objective: Sinus of valsalva aneurysm (SVA) is a rare aortic lesions and arise from congenital or acquired weakening of aortic medium at the junction with the aortic annulus. SVA may remain asymptomatic until they rupture. Different surgical strategies have been evolved for the surgical treatment of ruptured SVA. It is not much known about the long term results of surgical treatment of ruptured SVA.

Method: We present a rare case of a 58-year-old male with a re-ruptured sinus of Valsalva aneurysm 34 years after primary surgical repair.

Results: A 58-Year-old male patient was admitted to our hospital because of sudden onset of chest pain. 34 years ago, he had undergone a surgical repair of ruptured of non-coronary SVA into the right atrium via transaortic approach and direct closure. At admission, the physical examination revealed sinus tachycardia and loud continuous cardiac murmur. The chest radiograph showed cardiomegaly, pulmonary congestion and calcified contour of the aortic root. A transesophageal echocardiography revealed a ruptured of a calcified aneurysm (diameter: 4 cm) of the non-coronary sinus of valsalva into the right atrium with the characteristic “wind sock” appearance, a markedly dilated right atrium, left to right shunting and a mild aortic valve regurgitation. We performed the surgical repair by a dual chamber approach (transaortic and right atrium). The calcified aneurysmal sac was completely excised and the resulted defect was repaired with Dacron patch. The non-coronary cusp of the aortic valve was implanted at the base of the patch. Commissural resuspensions were needed to achieve aortic valve competence. The postoperative course was uneventful. At 4-year follow-up, the patient is doing well and the control echocardiogram showed competent aortic valve.

Conclusion: Recurrence of aneurysmal formation of the sinuses of vlsalva after primary surgical repair is not excluded. Different surgical strategies have been evolved for the surgical treatment of ruptured SVA from simple primary closure to patching of the rupture site by a dual chamber approach. Dual chamber (the involved chamber and aorta) approach is feasible and offers optimal exposure for surgical repair. However, long-term follow-up after surgical repair of SVA with modern diagnostic tools is recommended because of possible aneurysmal recurrence.