, Volume 37, Issue 1, pp 278-280
Date: 13 Mar 2013

Direct Percutaneous Puncture and Embolization of Ruptured Sinus of Valsalva Aneurysm

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Introduction

A 66-year-old man presented to the emergency department with hypotension and sudden-onset chest pain. His only medical history was medication-controlled hypertension. Computed tomography (CT) angiogram demonstrated a 6-cm sinus of Valsalva aneurysm (SVA) arising from the right coronary sinus with rupture into the pericardium (Fig. 1). Transoesophageal echocardiogram (TOE) showed mild aortic regurgitation and good left-ventricular function. Emergency open surgical repair of the aneurysm was undertaken by way of aortotomy using a 4-cm homograft–Hemashield patch (Meadox, Oakland, NJ). Aortic valve replacement was also performed with 27-mm porcine bioprosthesis (St. Jude Medical, St. Paul, MN). Postoperative TOE showed no paraprosthetic leak, but it did reveal sluggish aneurysm refilling, which was considered likely ooze through needle holes in the patch. Follow-up TOE 3 days later showed persistent filling of the aneurysm sac. An endovascular attempt to close the aneurysm was ...