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


Anju Sarupria, Poonam Malhotra Kapoor, Neeti Makhija, Usha Kiran 
 Departments of Cardiac Anaesthesia, CN Centre, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Anju Sarupria
Departments of Cardiac Anaesthesia, CN Centre, All India Institute of Medical Sciences, New Delhi
India




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;15:156-157


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 2022 May 18 ];15:156-157
Available from: https://www.annals.in/text.asp?2012/15/2/156/95081


Full Text

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 1}

References

1Chu 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.
2Zhao 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.
3Arora 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.
4Chang 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.