Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, with an incidence
of less than 1% of open heart surgery cases. Its evolution is most frequently silent,
being found incidentally or discovered in the event of its acute rupture. Non-ruptured
giant SVAs may cause unusual clinical manifestations, as a consequence of their protrusion
into the heart chambers or compression of the coronary vessels and are frequently
associated with aortic insufficiency of various degrees of severity. The gold standard
treatment for SVAs consists of complete replacement of the aortic root and valve.
However, in certain cases, valve-sparing procedures may prove to be a more suitable
alternative.A 68-year-old male patient presented with dyspnea as symptom caused by
a large (> 5 cm) right sinus of Valsalva aneurysm. The aneurysm was occupying most
of the right ventricle and was associated with severe aortic regurgitation. The surgical
treatment of the condition involved valve-sparing root reconstruction procedure (remodeling
technique), completed with external stabilization of the aortic valve annulus via
running suture annuloplasty. Following the uneventful intervention, the patient did
well and his status improved. The follow-up transthoracic echocardiography obtained
1 month after surgery showed a fully competent aortic valve with no regurgitation.Despite
complete aortic root and valve replacement being considered the safest approach to
large SVAs complicated with aortic insufficiency, valve-sparing procedures should
not be overlooked in case of a dilated aortic root with uncalcified aortic valve.
Performing valve-sparing by applying a remodeling technique operation completed with
annuloplasty reduces aortic valve insufficiency, avoiding side-effects related to
implanted valves.
