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A case of rupture of right coronary sinus of Valsalva aneurysm after aortic root replacement due to Stanford type A aortic dissection 15years ago

A case of rupture of right coronary sinus of Valsalva aneurysm after aortic root replacement due... Journal of Echocardiography (2022) 20:130–131 https://doi.org/10.1007/s12574-020-00505-6 C ASE IMAGE IN C ARDIO VASCUL AR ULTR ASOUND A case of rupture of right coronary sinus of Valsalva aneurysm after aortic root replacement due to Stanford type A aortic dissection 15 years ago 1 1 1 1 1 1 Satoshi Koto  · Koichiro Imai  · Ryotaro Yamada  · Teruyoshi Kume  · Yoji Neishi  · Shiro Uemura Received: 10 June 2020 / Revised: 24 November 2020 / Accepted: 25 November 2020 / Published online: 3 January 2021 © The Author(s) 2021 Case report Photomicrograph showing the inner wall of the excised artificial blood vessel. Fibrous capsule appears (black arrow) A 70-year-old Japanese man presented with symptom of and fibrin deposition is also observed (white arrow) (hema- a dyspnea and diagnosed as rupture of right coronary of toxylin and eosin stain, original magnification 3 × 20 × 2) sinus of Valsalva aneurysm. He had a history of ascending (Fig. 1f). aortic replacement because of Stanford type A aortic dis- We experienced a case of ruptured sinus of Valsalva section 15 years ago. Cardiovascular examination revealed a aneurysm after ascending aortic replacement for Stanford grade IV/VI continuous cardiac murmur at the right second type A dissection 15 years ago. In this case, gelatin–res- intercostal space. Transthoracic echocardiography (TTE) orcin–formalin (GRF) glue was used for ascending aortic revealed shunt through from right coronary sinus of Val- replacement. The surgical performance of acute aortic dis- salva aneurysm to right ventricle detected by color Dop- section had greatly improved by the appearance of GRF glue pler (Fig. 1a) Two- and three-dimensional transesophageal since 1980. However, stump-plasty using GRF glue has been echocardiography (3DTEE) revealed a ruptured aneurysm reported to cause postoperative anastomotic complications of the right coronary sinus of Valsalva causing a large left- in 5–20% [1, 2]. Pathological examination showed fragility to-right shunt through into the right ventricle (Fig. 1b) and of the aorta media and coagulation necrosis due to formalin- defect in right coronary sinus of Valsalva during cardiac induced tissue injury [3]. Although GRF glue is rarely used, cycle (Fig. 1c, d). We decided to perform re-ascending aorta it had been used in many cases previously. Therefore, it is replacement with aortic valve replacement. A ruptured coro- necessary to observe the occurrence of anatomic complica- nary aneurysm was observed in the right sinus of Valsalva. tions carefully over the long term. The rupture site was accompanied by the destruction of the wall structure (Fig. 1e). * Koichiro Imai kichiro@med.kawasaki-m.ac.jp Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan Vol:.(1234567890) 1 3 Journal of Echocardiography (2022) 20:130–131 131 Fig. 1 HYPERLINK "sps:id::fig1||locator::gr1||MediaObject::0"a atrium, LCSV left coronary sinus of Valsalva, RCSV right coronary Transthoracic echocardiograph by color Doppler shows right coro- sinus of Valsalva, LAA left atrial appendage. d Three-dimensional nary sinus of Valsalva aneurysm (red arrow) and shunt through from transesophageal echocardiography detect defect in right coronary right coronary sinus of Valsalva to right ventricle (yellow arrow). RA sinus of Valsalva (white arrow) in systole. e Operative findings: view right atrium, RV right ventricle, Ao aorta. b Transesophageal echocar- from the left ventricle side. Rupture of right coronary sinus of Val- diography by color Doppler shows shunt through from right coronary salva. f Photomicrograph showing the inner wall of the excised arti- sinus of Valsalva to right ventricle (yellow arrow). LA left atrium, ficial blood vessel. Fibrous capsule appears (black arrow) and fibrin LV left ventricle, RV right ventricle, Ao aorta. c Three-dimensional deposition is also observed (white arrow) (hematoxylin and eosin transesophageal echocardiography detect defect in right coronary stain, original magnification 3 × 20 × 2) sinus of Valsalva (white arrow) in diastole. LA left atrium, RA right Compliance with ethical standards Reference Conflict of interest Satoshi Koto, Koichiro Imai, Ryotaro Yamada, 1. Hata M, Shiono M, Sezai A, et al. Type A acute aortic dissection: Teruyoshi Kume, Yoji Neishi and Shiro Uemura declare that they have immediate and mid-term results of emergency aortic replacement no conflict of interest. with the aid of gelatin resorcin formalin glue. Ann Thorac Surg. 2004;78:853–7. Human rights statements and informed consent All procedures fol- 2. Izutani H, Shibukawa T, Kawamoto J, et  al. Devastating late lowed were in accordance with the ethical standards of the responsible complication for repair of type A acute aortic dissection with committee on human experimentation (institutional and national) and usage of gelatin-resorcinol-formalin glue. Int Cardiovasc Surg. with the Helsinki Declaration of 1964 and later revisions. Informed 2007;6:240–2. consent was obtained from all patients for being included in the study. 3. Kazui T, Washiyama N, Bashar AH, et al. Role of biologic glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root. Ann Thorac Surg. Open Access This article is licensed under a Creative Commons Attri- 2001;72:509–14. bution 4.0 International License, which permits use, sharing, adapta- tion, distribution and reproduction in any medium or format, as long Publisher’s Note Springer Nature remains neutral with regard to as you give appropriate credit to the original author(s) and the source, jurisdictional claims in published maps and institutional affiliations. provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Echocardiography Springer Journals

A case of rupture of right coronary sinus of Valsalva aneurysm after aortic root replacement due to Stanford type A aortic dissection 15years ago

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Springer Journals
Copyright
Copyright © The Author(s) 2021
ISSN
1349-0222
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1880-344X
DOI
10.1007/s12574-020-00505-6
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Abstract

Journal of Echocardiography (2022) 20:130–131 https://doi.org/10.1007/s12574-020-00505-6 C ASE IMAGE IN C ARDIO VASCUL AR ULTR ASOUND A case of rupture of right coronary sinus of Valsalva aneurysm after aortic root replacement due to Stanford type A aortic dissection 15 years ago 1 1 1 1 1 1 Satoshi Koto  · Koichiro Imai  · Ryotaro Yamada  · Teruyoshi Kume  · Yoji Neishi  · Shiro Uemura Received: 10 June 2020 / Revised: 24 November 2020 / Accepted: 25 November 2020 / Published online: 3 January 2021 © The Author(s) 2021 Case report Photomicrograph showing the inner wall of the excised artificial blood vessel. Fibrous capsule appears (black arrow) A 70-year-old Japanese man presented with symptom of and fibrin deposition is also observed (white arrow) (hema- a dyspnea and diagnosed as rupture of right coronary of toxylin and eosin stain, original magnification 3 × 20 × 2) sinus of Valsalva aneurysm. He had a history of ascending (Fig. 1f). aortic replacement because of Stanford type A aortic dis- We experienced a case of ruptured sinus of Valsalva section 15 years ago. Cardiovascular examination revealed a aneurysm after ascending aortic replacement for Stanford grade IV/VI continuous cardiac murmur at the right second type A dissection 15 years ago. In this case, gelatin–res- intercostal space. Transthoracic echocardiography (TTE) orcin–formalin (GRF) glue was used for ascending aortic revealed shunt through from right coronary sinus of Val- replacement. The surgical performance of acute aortic dis- salva aneurysm to right ventricle detected by color Dop- section had greatly improved by the appearance of GRF glue pler (Fig. 1a) Two- and three-dimensional transesophageal since 1980. However, stump-plasty using GRF glue has been echocardiography (3DTEE) revealed a ruptured aneurysm reported to cause postoperative anastomotic complications of the right coronary sinus of Valsalva causing a large left- in 5–20% [1, 2]. Pathological examination showed fragility to-right shunt through into the right ventricle (Fig. 1b) and of the aorta media and coagulation necrosis due to formalin- defect in right coronary sinus of Valsalva during cardiac induced tissue injury [3]. Although GRF glue is rarely used, cycle (Fig. 1c, d). We decided to perform re-ascending aorta it had been used in many cases previously. Therefore, it is replacement with aortic valve replacement. A ruptured coro- necessary to observe the occurrence of anatomic complica- nary aneurysm was observed in the right sinus of Valsalva. tions carefully over the long term. The rupture site was accompanied by the destruction of the wall structure (Fig. 1e). * Koichiro Imai kichiro@med.kawasaki-m.ac.jp Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan Vol:.(1234567890) 1 3 Journal of Echocardiography (2022) 20:130–131 131 Fig. 1 HYPERLINK "sps:id::fig1||locator::gr1||MediaObject::0"a atrium, LCSV left coronary sinus of Valsalva, RCSV right coronary Transthoracic echocardiograph by color Doppler shows right coro- sinus of Valsalva, LAA left atrial appendage. d Three-dimensional nary sinus of Valsalva aneurysm (red arrow) and shunt through from transesophageal echocardiography detect defect in right coronary right coronary sinus of Valsalva to right ventricle (yellow arrow). RA sinus of Valsalva (white arrow) in systole. e Operative findings: view right atrium, RV right ventricle, Ao aorta. b Transesophageal echocar- from the left ventricle side. Rupture of right coronary sinus of Val- diography by color Doppler shows shunt through from right coronary salva. f Photomicrograph showing the inner wall of the excised arti- sinus of Valsalva to right ventricle (yellow arrow). LA left atrium, ficial blood vessel. Fibrous capsule appears (black arrow) and fibrin LV left ventricle, RV right ventricle, Ao aorta. c Three-dimensional deposition is also observed (white arrow) (hematoxylin and eosin transesophageal echocardiography detect defect in right coronary stain, original magnification 3 × 20 × 2) sinus of Valsalva (white arrow) in diastole. LA left atrium, RA right Compliance with ethical standards Reference Conflict of interest Satoshi Koto, Koichiro Imai, Ryotaro Yamada, 1. Hata M, Shiono M, Sezai A, et al. Type A acute aortic dissection: Teruyoshi Kume, Yoji Neishi and Shiro Uemura declare that they have immediate and mid-term results of emergency aortic replacement no conflict of interest. with the aid of gelatin resorcin formalin glue. Ann Thorac Surg. 2004;78:853–7. Human rights statements and informed consent All procedures fol- 2. Izutani H, Shibukawa T, Kawamoto J, et  al. Devastating late lowed were in accordance with the ethical standards of the responsible complication for repair of type A acute aortic dissection with committee on human experimentation (institutional and national) and usage of gelatin-resorcinol-formalin glue. Int Cardiovasc Surg. with the Helsinki Declaration of 1964 and later revisions. Informed 2007;6:240–2. consent was obtained from all patients for being included in the study. 3. Kazui T, Washiyama N, Bashar AH, et al. Role of biologic glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root. Ann Thorac Surg. Open Access This article is licensed under a Creative Commons Attri- 2001;72:509–14. bution 4.0 International License, which permits use, sharing, adapta- tion, distribution and reproduction in any medium or format, as long Publisher’s Note Springer Nature remains neutral with regard to as you give appropriate credit to the original author(s) and the source, jurisdictional claims in published maps and institutional affiliations. provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 1 3

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Journal of EchocardiographySpringer Journals

Published: Jun 1, 2022

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