Successful Repair of a Ruptured Sinus of Valsalva Following Blunt Chest Traumatic Injury

P0313 

Case Video Submission 

Nicholas Ray (1), Philipos Gebremedhin (1), Sasha Adams (1), Michelle McNutt (1), Thanila Macedo (1), Anthony Estrera (1), steven eisenberg (1)

(1) UTHealth Medical School, Houston, TX

Nicholas Ray    -  Contact Me
UTHealth Medical School

Philipos Gebremedhin    -  Contact Me
UTHealth Medical School

Sasha Adams    -  Contact Me
UTHealth Medical School

Michelle McNutt    -  Contact Me
UTHealth Medical School

Thanila Macedo    -  Contact Me
UTHealth Medical School

*Anthony Estrera    -  Contact Me
UTHealth Medical School

steven eisenberg    -  Contact Me
UTHealth Medical School

Nicholas Ray    -  Contact Me
N/A

Objective
Sinus of Valsalva aneurysms (SOVA) is a rare congenital or acquired condition of the aortic root. Ruptured SOVA typically involves another chamber of the heart. Free wall rupture of the SOVA is usually associated with sudden death due to tamponade. We report a case of blunt trauma resulting in the rupture of the non-coronary sinuses of Valsalva, which was successfully repaired.

Case Presentation
The patient is a 47-year-old male with a past medical history of sternotomy for penetrating trauma who recently sustained blunt chest trauma. Upon arrival, the patient complained of chest pain and shortness of breath. The transthoracic echocardiograph reveals a rupture of the sinus of Valsalva. The rupture is near the aortic root's non-coronary cusp (NCC). Axial view of chest CT showing disruption of the non-coronary sinus (NCC) with contained posterior hematoma within the mediastinum.

The patient underwent a redo sternotomy, revealing a rupture of the non-coronary aortic root sinuses. He received a biological aortic root reconstruction. After a prolonged hospital course, he was discharged to home and resumed all normal activities upon outpatient follow-up.

Conclusion
A literature search did not identify any reports of long-term survival following emergency surgical intervention for traumatic, free rupture of the Sinuses of Valsalva. We identified reports of non-traumatic ruptures of the SOVA into the pericardium causing tamponade.1 The unique feature of this case was the acute traumatic cause of the rupture, the distinct CT and TTE findings, and the successful aortic valve replacement. The history of sternotomy for penetrating trauma possibly contributed to the patient's survival.

Traumatic free wall ruptured sinus of Valsalva into the mediastinum can show specific radiological findings; rapid surgical correction should ensue.

Trauma