Page 12 - Journal of Structural Heart Disease Volume 2, Issue 5

Original Research Article
Journal of Structural Heart Disease, October 2016, Volume 2, Issue 5:213-216
DOI: http://dx.doi.org/10.12945/j.jshd.2016.008.15
Received: July 28, 2015 Accepted: August 05, 2015 Published online: October 2016
Transcatheter Closure of a Ruptured Sinus of Valsalva Aneurysm with the Amplatzer Ductal Occluder II in a 6-Year-Old Girl
Damien Kenny, MB, MD1*, Nelly Gomez, MD2, Juan Ramirez, MD2
1 Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Illinois, USA 2 Clinica Corominas, Santiago De Los Caballeros, Dominican Republic
Abstract
We report the successful deployment of a 6 mm Amplatzer Ductal Occluder II via a retrograde approach to treat full occlusion of a type II ruptured right sinus of Valsalva aneurysm in a symptomatic 6-year-old girl with signi cant left-heart dilation.
Copyright © 2016 Science International Corp.
Key Words
Occlusion • Sinus of Valsalva • Device
Introduction
Sinus of Valsalva aneurysm is a rare congenital condition accounting for less than 1% of all congenital anomalies, although the prevalence is higher in Asia. It occurs due to deficient elastic fibers in the aortic media, leading to progressive dilatation over time, and should be differentiated from acquired aneurysms caused by infections or connective tissue disorders. The right sinus of Valsalva is affected in up to 85% of cases. A classification system has been reported based on the origin of the aneurysm in relation to the right and noncoronary sinuses [1]. Rupture may be precipitated by an exertional event and usually occurs into the right atrium or ventricle, leading to significant left-to-right shunt and congestive cardiac failure. Once the clinical diagnosis has
been confirmed on echocardiography, advanced imaging modalities may be used to clarify the aneurysm morphology because there may be multiple ostia from the aneurysm into the right heart, and this may influence the closure approach.
Case Presentation
A 6-year-old girl was referred with increasing fatigue and was noted to have a harsh grade IV long systolic murmur. She had bounding pulses, and chest x-ray revealed a large heart with increased pulmonary vascular markings. Transthoracic echocardiogram (TTE) demonstrated a dilated left heart with preserved systolic ventricular function and turbulent ow on color Doppler from the aortic root into the pulmonary out ow. This was initially thought to be an aortopulmonary window, but further assessment con rmed that the ow from the aortic root was entering the right ventricular out ow tract (RVOT) beneath the pulmonary valve. The jet measuring 6 mm in diameter originated from the midpoint of the right coronary sinus into the RVOT, with persistence of ow into diastole (although a diastolic component to the murmur was not clearly audible), consistent with a type II ruptured sinus of Valsalva aneurysm according to the original Sakakibara classi cation [1]. There was an eccentric jet of aortic incompetence graded as mild.
* Corresponding Author:
Damien Kenny, MB, MD
Rush Center for Congenital & Structural Heart Disease
Department of Cardiology
1650 W. Harrison St, Chicago, IL 60612, USA
Tel.: +1 312 942 6800; Fax: +1 312 942 5869; E-Mail: damien_Kenny@rush.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2016 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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