Discussion
Sinus of Valsalva (SOA) aneurysms defined as a significant dilatation or
enlargement of the aortic root area, which located between the aortic
valve annulus and the sinotubular junction [1]. The incidences of
the right coronary sinus, noncoronary sinus and left coronary sinus
aneurysms are approximately 70-90%,10-20% and <5%,
respectively. It is a rare aortic root anomaly, associated with
congenital defects in the aortic media, and rarely due to acquired
conditions [2]. Rupture of SOV is a rare complication, the
consequence of which depends on its location. Rupture can occur into
four cardiac chambers, but rarely into the interventricular septum (IVS)
[3]. In our case, the patient had bicuspid aortic valve and two
coronary sinus, ruptured anterior SOV aneurysm formed paravalvular
aortic root pseudoaneurysm, which was communicated with IVS dissecting
aneurysm.
Aortic root pseudoaneurysm is usually occurring secondary to trauma,
infection, prosthetic valve endocarditis, etc. The main complications of
pseudoaneurysms are compression of the surrounding tissue, thrombus
formation in the aneurysm cavity, and cardiogenic embolism. In this
case, the large pseudoaneurysm invade the IVS dissecting aneurysm
extending from the basal anteroseptum to anterior
wall of the left ventricle, which the IVS muscle tore two layers to form
cystic cavity.
In the literature report, IVS dissecting aneurysm is a rare
complication, which caused by ruptured aneurysm of the SOV, congenital
coronary artery fistulas, infective endocarditis, or myocardial
infarction [4]. We present a rare case of IVS dissecting aneurysm
that resulted from a paravalvular aortic root pseudoaneurysm, which may
cause significant hemodynamic and anatomical derangements. It has a
progressive course and a poor prognosis, and may cause arrhythmias,
conduction abnormalities, or congestive heart failure [5]. The
complaint of this patient was chest pain and had heart failure
initially, one possible explanation is that disrupted aortic root
anatomy and massive IVS dissecting aneurysm compresses the coronary
arteries leading to myocardial ischemia [6][7].