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Year : 2012  |  Volume : 15  |  Issue : 2  |  Page : 156-157
Trans-esophageal echocardiography: An indispensible guide for transcatheter device closure of ruptured sinus of Valsalva aneurysm


Departments of Cardiac Anaesthesia, CN Centre, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication16-Apr-2012
 

How to cite this article:
Sarupria A, Kapoor PM, Makhija N, Kiran U. Trans-esophageal echocardiography: An indispensible guide for transcatheter device closure of ruptured sinus of Valsalva aneurysm. Ann Card Anaesth 2012;15:156-7

How to cite this URL:
Sarupria A, Kapoor PM, Makhija N, Kiran U. Trans-esophageal echocardiography: An indispensible guide for transcatheter device closure of ruptured sinus of Valsalva aneurysm. Ann Card Anaesth [serial online] 2012 [cited 2019 Jul 21];15:156-7. Available from: http://www.annals.in/text.asp?2012/15/2/156/95081


Ruptured sinus of Valsalva aneurysm (SOVA) is a rare but well-described clinical entity. Sinus of Valsalva aneurysm is five times more common in Asians in whom it presents typically in adolescence and young adulthood. [1] Successful transcatheter closure (TCC) is being increasingly reported as single case reports or small series. [2],[3],[4]

A 20-year-old boy presented with shortness of breath and chest pain since 1 week. Two-dimensional transthoracic echocardiography (TTE) revealed sinus of valsalva aneurysm from right coronary sinus rupturing into right atrium. Being an isolated RSOV patient was taken for transcatheter device closure.The procedure was performed under general anesthesia with TEE guidance [Figure 1]a-e. The femoral vein and artery were accessed. Intravenous heparin (100 IU/kg) and cefazolin were given. Right and left heart pressures and saturations were obtained, and aortic root angiography was performed. The ruptured SOVA was measured at its aortic end as well as at the rupture site on TEE [Figure 1]a. The larger of the two measurements was considered for device selection. The size of the amplatzer duct occluder (ADO) selected was such that its aortic segment was 2-4 mm larger than this diameter. An appropriately sized ADO (10/8 mm) with its attached delivery cable was then inserted through the delivery sheath, and its aortic disk was deployed in the ascending aorta. The whole assembly was pulled back till the aortic disk blocked the aortic end of the SOVA as seen on TEE. After confirming the precise placement, the rest of the ADO was deployed on the right side across the defect. The ADO was then released from the delivery cable only after making certain that there was no significant aortic regurgitation (AR), tricuspid regurgitation (TR), residual shunt, or any encroachment on coronary arteries as seen on TEE [Figure 1]d and e.
Figure 1a: Mid-esophageal aortic sax view showing windsock aneurysm arising from right coronary sinus rupturing into rightatrium . AV - Aortic valve; RA - Right atrium; TV - Tricuspid valve; RSOV - Ruptured sinus of Valsalva
Figure1b: Mid-esophageal aortic lax view showing catheter entering from the right coronary sinus into ruptured sinus of valsalva into right atrium. ADO- Amplatzer duct occluder; AV - Aortic valve; RA - Right atrium; TV- Tricuspid valve; RSOV - Ruptured sinus of Valsalva
Figure 1c: Mid-esophageal aortic lax view showing amplatzer delivery sheath entering from right atrium into ruptured sinus of valsalva into ascending aorta. ADO - Amplatzer duct occluder; AV - Aortic valve; RA - Right atrium; TV - Tricuspid valve; RSOV - Ruptured sinus of Valsalva
Figure 1d: Mid-esophageal aortic lax view showing amplatzer duct occluder closing the defect . ADO - Amplatzer duct occluder; AV - Aortic valve; RA - Right atrium; TV - Tricuspid valve; RSOV - Ruptured sinus of Valsalva
Figure 1e: Mid-esophageal aortic SAX view showing amplatzer duct occluder into right coronary sinus. ADO - Amplatzer duct occluder; AV - Aortic valve; RA - Right atrium; TV - Tricuspid valve; RSOV - Ruptured sinus of Valsalva


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   References Top

1.Chu SH, Hung CR, How SS, Chang H, Wang SS, Tsai CH, et al. Ruptured aneurysms of the sinus of Valsalva in Oriental patients. J Thorac Cardiovasc Surg 1990;99:288-98.  Back to cited text no. 1
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2.Zhao SH, Yan CW, Zhu XY, Li JJ, Xu NX, Jiang SL, et al. Transcatheter occlusion of the ruptured sinus of Valsalva aneurysm with an Amplatzer duct occluder. Int J Cardiol 2008;129:81-5.  Back to cited text no. 2
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3.Arora R, Trehan V, Rangasetty UM, Mukhopadhyay S, Thakur AK, Kalra GS, et al. Transcatheter closure of ruptured sinus of valsalva aneurysm. J Interv Cardiol 2004;17:53.  Back to cited text no. 3
    
4.Chang CW, Chiu SN, Wu ET, Tsai SK, Wu MH, Wang JK, et al. Transcatheter closure of a ruptured sinus of valsalva aneurysm. Circ J 2006;70:1043-7.  Back to cited text no. 4
    

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Correspondence Address:
Anju Sarupria
Departments of Cardiac Anaesthesia, CN Centre, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.95081

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