Right ventricular outflow tract obstruction caused by sinus of Valsalva aneurysm
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CASE REPORT
Right ventricular outflow tract obstruction caused by sinus of Valsalva aneurysm Soichiro Henmi1 · Koki Yokawa1 · Yutaka Okita1 Received: 7 July 2020 / Accepted: 1 November 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Right ventricular outflow tract (RVOT) obstruction caused by sinus of Valsalva aneurysm is a rare observation. We describe a successful case of valve-sparing root replacement using reimplantation technique for RVOT obstruction by a large right coronary sinus of Valsalva aneurysm in a 76-year-old man. In the pathological examination, the elastic fibers of the medial layer were defective not only in the wall of the aneurysmal Valsalva sinus but also in the remaining two sinus walls. Our experience illustrated that valve-sparing root replacement can be an effective procedure in such a case. Keywords Right ventricular outflow tract obstruction · Sinus of valsalva aneurysm · Valve-sparing root replacement
Introduction
Case
Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly with an incidence of 0.38–1.5% among all cardiac surgical procedures. Most often, these aneurysms are caused by connective tissue disorder, congenital, infectious, traumatic, or degenerative diseases. SVA usually remain silent and are detected only as incidental findings in the event of a rupture into the neighboring structures or upon imaging results performed for other indications. In our case, the patient complained of repeated dizziness and preoperative examination demonstrated severe right ventricular outflow tract (RVOT) obstruction caused by a non-ruptured large aneurysm of the right coronary sinus of Valsalva. We performed valve-sparing root replacement using reimplantation technique in this case and achieved an excellent outcome.
A 76-year-old man complaining of dizziness was consulted at our hospital. A contrast-enhanced computed tomography (CT) revealed a right coronary sinus of Valsalva protruding into the RVOT and measuring 27 × 33 × 32 mm (Fig. 1a–c). The aortic valves and the rest of the aortic root were normal (ventriculo-arterial junction: 23.5 mm, sinotubular junction: 29.6 mm), and there was no aortic regurgitation (AR). There was neither thrombi in the aneurysm nor shunt flow from it to the right ventricle. Right ventriculography also revealed extremely narrow RVOT (Fig. 2a). Both cardiac catherization and cardiac echocardiography (Fig. 2b) showed high PG between the right ventricle and pulmonary artery. However, pulmonary artery and valve were not involved. Valve-sparing root replacement (VSRR) with the reimplantation technique was performed (Video 1). A median sternotomy was done, and a huge aneurysm was found at the anterior of the aortic root, and the right coronary artery originated from the distal end of the aneurysm. Under cardiopulmonary bypass and cardioplegic arrest, the aortic root was replaced using a 24-mm Dacron graft (Vascutek Gelweave Valsalva Graft, Terumo Cardiovascular Systems Corporation, Ann Arbor, MI) using the reimplantation technique in addition
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