Ruptured Left Coronary Sinus of ValsalvaAneurysm Into the Left VentricleTakayuki Saito, MD, Miki Asano, MD, Michiko Ishida, MD, Shigeru Sasaki, MD,Norikazu Nomura, MD, Tomohiko Ukai, MD, and Akira Mishima, MDDepartment of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

Ruptured aneurysm originating from the left coronarysinus toward the left ventricle (LV) is an extremely

rare problem and the incidence was reported as 1.8% ofall ruptured sinus Valsalva aneurysms [1]. This can causesevere aortic regurgitation, coronary insufficiency, andparoxysmal ventricular fibrillation [2].

A 59-year-old Japanese male presented with exertionaldyspnea. Chest roentogenogram revealed bilateral pleu-ral effusion and cardiomegaly. Two hours after his ad-mission he required resuscitation because of suddencardiopulmonary arrest. A two-dimensional echocardio-gram demonstrated severe aortic regurgitation with com-pensated LV contractility. Initially he was treated withintensive medical care for congestive heart failure. De-finitive diagnosis was confirmed on left-sided catheter-ization. The aortogram showed the “wind-sock” appear-ance of the aneurismal sac arising from the left coronarysinus extruding into the LV (arrow in Fig 1). The leftcoronary artery was intact (arrowhead in Fig 1) and noassociated lesion, such as ventricular septal defect, wasidentified.

Standard cardiopulmonary bypass was used during

repair. The aneurysm was exposed through an obliqueaortotomy. The aortic valvular ring at the left coronarysinus had detached completely from the aortic wall. Thesac tightly adhered to the free wall of the LV and thebottom of the sac had perforated (asterisk in Fig 2). Theleft coronary cusp, valvular ring (arrowheads in Fig 2), andfree wall of the aneurysmal sac were removed together.In order to obtain firm anchorage of a mechanical valve,mattress sutures with Teflon pledgets at the defect ofvalvular ring were directly placed on the aortoventricularjunction where aneurismal wall adhering to the endocar-dium had turned into scar tissue. Histologic examinationshowed an accumulation of inflammatory cells (not onlymononuclear cells but also neutrophiles) implying that apossible cause of aneurysmal formation was an infectiveendocarditis although any organisms could be identifiedfrom these specimens.

References

1. Au WK, Chiu SW, Mok CK, Lee WT, Cheung D, He GW.Repair of ruptured sinus of valsalva aneurysm: determinantsof long-term survival. Ann Thorac Surg 1998;66:1604–10.

2. Glock Y, Ferrarini JM, Puel J, Fauvel JM, Bounhourne JP, PuelP. Isolated aneurysm of the left sinus of Valsalva. Ruptureinto the left atrium, left ventricle and dynamic coronaryconstriction. J Cardiovasc Surg (Torino) 1990;31:235–8.

Address reprint requests to Dr Mishima, Department of CardiovascularSurgery, Nagoya City University Graduate School of Medical Sciences, 1Kawasumi, Mizuho, Nagoya 467-8601, Japan; e-mail: mishima@med.nagoya-cu.ac.jp.

Fig 1.Fig 2.

© 2004 by The Society of Thoracic Surgeons Ann Thorac Surg 2004;78:2187 • 0003-4975/04/$30.00Published by Elsevier Inc doi:10.1016/S0003-4975(03)01417-6

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