Recognition by Doppler of the ruptured Valsava sinus aneurysm

pp 185-188

Abstract

Sinus of Valsalva aneurysms (SVA) are a rare entity. Its rupture may be suspected clinically and through the echo. Until recently the cath was the only way to confirm it. Fourteen cases of ruptured SVA studied by Doppler have been published up to now. That is why we report two cases, anatomically confirmed, diagnosed by this method. A woman (21) and a man (43), case 1 and 2 respectivelly, complained effort- dyspnea. They had continuous murmur and no defined diagnosis. Echo revealed dilatation of the right S V with apparent holes, on both of them. Systolic and diastolic aliasing was depicted with pulsed Doppler mode in the right ventricular outflow tract (RVOT). Continuous mode showed that the sunt flow was faster in diastole. The pulmonic flow was higher than normal. Case 1 had holodiastolic reverse flow into the abdominal aorta. No one had valvular aortic insufficiency (AI). All of this finding were confirmed by cath. Case 1 was operated by direct suture. Postoperative Doppler was normal. Case 2 refused surgery andi died two months later because of heart failure. Autopsy showed a thin wall S VA with multiple holes, protruding into the R VOT. It is concluded that it is possible to confirm by Doppler the presence and placement of the rupture of a SVA, to estimate the shunt volume assessing flows distally to the chamber receiving it, and to depict associated defects, such as AI and VSD.