An aneurysm of sinus Valsalva is a rare congenital or acquired heart disease, which is a fingerlike or pouchy protrusion of the aortic wall next to the semilunar valves. In most cases, this defect is congenital and occurs in boys.
Features of
The sinus aneurysm of Valsalva is most often found in the region of the right coronary sinus, in a quarter of cases in the region of the posterior( non-coronary) sinus and in only five percent of patients it is registered in the left coronary sinus region. Aneurysm of all three sinuses occurs occasionally, but this case is so rare that in practice most cardiosurgeons do not occur. The aneurysmal sac can reach a size of three centimeters.
Very often an aneurysm terminates with one or more perforations that allow the root of the aorta to communicate with the corresponding cardiac chamber. Doctors distinguish several patterns of aneurysm rupture in certain parts of the heart.
- Left and central aneurysms of the right coronary sinus, as a rule, are torn into the excretory compartment of the right ventricle.
- An aneurysm of the right side of the right sinus breaks into either the right atrial cavity or the inflow of the right ventricle.
- Very rare aneurysms of the left coronary sinus are usually ruptured extracardially, into the cavity of the right atrium or right ventricle.
About the causes of root aneurysms at the sinus level of Valsalva read further.
Causes of
The main cause of sinus aneurysm in Valsalva is considered to be poor heredity. In people whose close relatives are sick with various defects of the heart muscle, the probability of a child with a defect is many times higher. Difficult passing pregnancy and poor fetal development in the womb can also cause an aortic aneurysm of the sinus of Valsalva.
The basis for the formation of this defect is the weakness of the connection between the fibrous ring and the aortic wall, which leads to a weakening of the medial( middle aortic membrane) and the formation of an aneurysm. At the time of the birth of a child, a defect may not be detected. In the future, during an aneurysmic sack increases in size, the walls become thinner and, as a result, tear. The rupture of an aneurysm in a patient occurs between the ages of twenty-five to forty, but sometimes even in childhood.
Acquired DIA can occur after the transfer of complex inflammatory and degenerative diseases, as well as severe chest injuries. All these causes lead to a dystrophy of the connective tissue, which is located on the inner surface of the sinuses.
Symptoms of
In young children, the sinus aneurysm of Valsalva almost always proceeds asymptomatically. Characteristic signs can manifest only in the presence of breakthroughs that occur during physical exertion:
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- heartbeat knocked down;
- nausea;
- pale appearance;
- loss of consciousness;
- acute chest pain;
- shortness of breath;
- dizziness.
Diagnosis
Physically, you can identify some signs of an aneurysm of the sinuses of the Valsalva:
- continuous and loud systolic murmur in the upper chest;
- pulmonary wheezing;
- Pasteur tremor;
- noise from the back at the base of the heart.
Diagnosis is as follows:
- Electrocardiography does not show any specific changes. In some cases, there is a noticeable overload of both ventricles and atrioventricular block, as well as nodal rhythm. Phonocardiography reveals high-amplitude noise.
- Echocardiography determines the state of the sinuses, the proximal aorta, the aortic valve and the entire surrounding structure. Using transoesophageal echocardiography, you can find the exact location of the rupture and determine the degree of bleeding.
- The chest X-ray shows an enlarged volume of the heart, especially the right part of the heart and augmentation of the pulmonary pattern.
- Using the method of retrograde aortography( introduction of a contrast agent into the root of the aorta), one can distinguish the location of the aneurysmal sac, its size and the presence of perforations.
- Also for the detection of this heart defect, a cardiologist can prescribe an MRI of the heart muscle and ventriculography.
Next, we'll talk about the methods of treating an aneurysm of the artery of the sinus of Valsalva.
For information on the aneurysm of Valsalva sinus, you will learn from the following video:
Treatment of
Medication and therapeutic
Conservative treatment of sinus aneurysms in Valsalva is aimed at hemodynamic stabilization, elimination of arrhythmia, prevention and treatment of infective endocarditis and cardiac ischemia.
It is important to know which pills and other medicines are used in the aortic aneurysm of the sinus of Valsalva. ACE inhibitors, diuretics, nitrates and β-adrenoblockers are used. Standard prophylaxis of endocarditis is performed.
On how to recover from an aortic aneurysm of the sinus of Valsalva by surgery, read below.
Surgery for sinus aortic aneurysm Valsalva
Removal of ASV is possible only by surgery - through surgery. The plastic of the aneurysm of the sinuses of Valsalva is being performed. Surgical intervention is performed when the artificial circulation is connected. Cardiac surgeons perform an operation through the right parts of the heart muscle.
Resection of the aneurysm and subsequent plastic and suturing is carried out, which are strengthened with special pads. If necessary, prosthetic repair of the aortic valve and additional plastic of the valves is also performed.
When a ruptured aneurysm of the sinuses of Valsalva, a transcatheter closure is performed. It is carried out under the control of echocardiography using special devices. The plasticity of the aneurysm of the sinus of Valsalva gives 100% recovery.
Scheme of supracoronary aortic aortic prosthesis
Prevention of disease
Prevention of the disease includes:
- maintaining a healthy lifestyle;
- walking in the fresh air;
- no physical activity;
- regular follow-up with a cardiologist;
- specialist advice.
Complications of
Possible complications for this heart failure:
- myocardial ischemia and angina pectoris;
- infective endocarditis( very often this disease is associated with microscopic ruptures);
- Acute or progressive sinus of Valsalva with congestive heart failure or aortic valve insufficiency;
- compression of the conduction system of the heart muscle followed by its blockade;
- aortopulmonary or aortobromhial fistula;
- systemic embolism with disturbed blood flow through the dilated unbroken sine.
Forecast
Lethal cases mainly occur when the aneurysm of the sinus of Valsalva ruptures and the subsequent severe severe aortic valve failure. If you do not operate the resulting sinus breakthrough, then death occurs about a year, sometimes a little later. It all depends on its location and the magnitude of the blood flow disorder.
After the surgery, the survival prognosis is very good, especially if there is no damage to the aortic valve. The lethal outcome is only five percent of the total mass of patients.
Prognosis in patients with unbreakable blemish is unknown, since the disease is completely asymptomatic.