Transcatheter closure of giant ruptured sinus of valsalva aneurysm.

A 41-year-old woman presented with paroxysmal chest pain, dyspnea, and palpitations, and a continuous heart murmur was heard over the right upper and lower sternal borders. Transthoracic echocardiography revealed a giant ruptured sinus of Valsalva aneurysm (SOVA), which had dislodged and ruptured into the right atrium adjacent to the tri-cuspid valve. The diameter of the aortic end of the defect was 4 mm. Interestingly, this windsock SOVA swung into the right atrium and the right ventricle during different phases of the cardiac cycle (Figure 1 and Movie I in the online-only Data Supplement). Biatrial enlargement showed that the left atrial volume was 54 mL and the right atrial volume was 91 mL. We attempted to perform a transcatheter closure of this ruptured giant SOVA at the aortic end of the rupture site. An aortic angiogram confirmed the presence of the giant windsock SOVA (Figure 2 and Movie II in the online-only Data Supplement). A 6-mm modified double-disk ventricular occluder (Shanghai Shape Memory Alloy Ltd, China), similar to the Amplatzer occluder, was used in this procedure. The modified occluder (Figure 3) was made of 0.005-in nitinol wire mesh with fabric inside. The diameter of the left disk was 4 mm larger than the waist, and the right disk was 2 mm larger than the waist. The waist of the occluder was 3 mm thick. The modified double-disk ventricular occluder was approved by the State Food and Drug Administration of the People's Republic of China in 2003. 1 During the postoperative evaluation , the right coronary ostium was located relatively high in relation to the SOVA. The ECG showed no changes in the S-T segment after the procedure. Transthoracic echocardiography was performed at that time, which revealed that the occluder was well fixed. There were no tricuspid or aortic regurgitation and no residual shunting. The aneurysm was shown to have been resolved completely; the left atrial volume was 47 mL, and the right atrial volume had decreased from 91 to 62 mL (Figure 4 and Movie III in the online-only Data Supplement). A repeat aortic angiogram confirmed that the giant SOVA had disappeared (Figure 5 and Movie IV in the online-only Data Supplement). SOVAs are relatively more common in adolescent and young adult Asian populations, with recorded incidences of 0.46% to 3.5% in Eastern countries compared with 0.14% to 0.23% in studies from Western areas. 2 It is usually a congenital anomaly …