Author + information
- Received September 19, 2012
- Accepted November 26, 2012
- Published online March 5, 2013.
- Steven L. Driver, MD, MPH*,
- Hayan Jouni, MD*,
- Daniel L. McCullough, RDCS†,
- Maurice Enriquez-Sarano, MD† and
- Hector I. Michelena, MD†
A 90-year-old man presented with a fall-related femur fracture in 2011. He had a right aneurysm of the sinus of Valsalva (SVA) first reported in 1999 (A,Online Video 1). Pre-surgical transthoracic echocardiogram revealed an enlarged right ventricular (RV) outflow tract, but the aneurysm was surprisingly not immediately apparent due to its large size and thinned walls (B). With color Doppler, the 4.5 × 4.5 cm aneurysm was delineated (C, D,Online Video 2). With intravenous contrast, the aneurysm took on the striking appearance of an “eclipse” of the RV outflow tract (E), without evidence of left-to-right shunting. The SVA slowly filled with swirling contrast media (F to I,Online Video 3) as it transitioned through the left ventricle (LV) and aortic root (Ao). There was moderate RV dysfunction and RV systolic pressure of 55 mm Hg, likely the result of chronic RV outflow tract obstruction. The patient elected to forego any intervention beyond surgery for his hip. At 12 years since initial diagnosis, this is the longest reported follow-up for SVA identified in an adult. LA = left atrium.
Drs. Driver and Jouni contributed equally to this work.
- Received September 19, 2012.
- Accepted November 26, 2012.
- American College of Cardiology Foundation