Contained rupture of a sinus of Valsalva aneurysm: Is it just a matter of luck?

J Cardiothorac Surg. 2022 Mar 28;17(1):58. doi: 10.1186/s13019-022-01800-2.

Abstract

Background: Contained rupture of the ascending aorta is a rare condition, but the severity of this complication enforces strict guidelines for its prevention and a prompt diagnosis, once already occurred.

Case presentation: A 66-year-old man with a history of type 2 diabetes, longstanding aortic valve stenosis and aortic root aneurysm of 47 mm was hospital admitted for elective surgery. A Bentall-De Bono procedure was performed in order to replace the stenotic bicuspid aortic valve and exclude the dilated portion of the aortic wall. Intraoperatively, a discontinuity of the aortic wall, just above the aortic annulus, at the non-coronary sinus of Valsalva was incidentally observed. The aortic wall discontinuity was none other than a contained aortic rupture. The preoperative CT-scan images were afterwards analyzed by the radiologist, in order to identify the contained aortic rupture. Indeed a false aneurysm of the non-coronary sinus of Valsalva of a maximum diameter of 15 mm was detected, thanks to a 3D reconstruction.

Conclusions: The diagnosis of contained aortic rupture is certainly demanding, particularly in absence of signs or symptoms of rupture in a chamber of the heart or in the pericardium. Although this case represents a consensus of experts' opinion, the recognition of these specific cases in which the risk of dissection, rupture or death is at its highest, would allow to operate at the appropriate time, improving the outcomes.

Keywords: Acute aortic syndrome; Aortic root replacement; Bicuspid aortic valve; Contained aortic rupture.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aorta / surgery
  • Aortic Aneurysm* / complications
  • Aortic Aneurysm* / diagnostic imaging
  • Aortic Aneurysm* / surgery
  • Aortic Rupture* / complications
  • Aortic Rupture* / diagnostic imaging
  • Aortic Rupture* / surgery
  • Diabetes Mellitus, Type 2* / complications
  • Humans
  • Male
  • Sinus of Valsalva* / diagnostic imaging
  • Sinus of Valsalva* / surgery